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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0010285 <br /> DATE RECEIVED by EHD: November 03,2014 APPL#: QX-990002 <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURG PE : 2656 <br /> REVISIONS TO ACTIONS (RA) <br /> COMPLETE& SUBMIT BY: Tue, November 18, 2014 <br /> Assigned to : EE0005944 ESCOTTO <br /> SITE ADDRESS: 23627 N MACKVILLE RD, CLEMENTS APN : 01922043 44 <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit (i.e., sewage disposal, water <br /> supplies, etc...). Where necessary, on an attached piece of plain paper, draw complete map of area showing population <br /> density, location of house, wind direction, etc.... <br /> Public Water: Public Sewer: <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> l/i, 2-14t�) <br /> -sz <br /> i <br /> I recommend: Approval Denial ❑ Continuance Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> 4 A/17 <br /> Ll rz <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> A 11 Check Off List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 November 04,2014 <br /> s�1! <br />