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r <br /> NOTE: PULL ALL RMITS (Septic, Well, etc.) MAKE":OPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0005971 <br /> DATE RECEIVED by EHD: March 21,2006 APPL#: PA-0600132 <br /> Referral Agency STAFF CONTACT: KATHY ALLEN PE : 2622 <br /> SUBDIVISON-MINOR(MS) <br /> COMPLETE&SUBMIT BY: Tue, April 4, 2006 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 29888 N MACKVILLE RD, CLEMENTS APN : 00917004 05 <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: /xj 24- <br /> Nam of PurveyorName of System <br /> SUMMARY OR COMMENTS: ���� — <br /> ✓rte c/��7�1 �.n�/ /7�io-->!/. i--�.�xrY <br /> i <br /> r <br /> 1 <br /> I recommend: Approval Er Denial � Continuance Insp or: ) <br /> - - Si ature <br /> Suoervisor/Lead Senior COMMENTS: <br /> r r <br /> NI ;IS tlf -. <br /> O1 <br /> h 11 0 t n n a$, a^uA la R¢en lie nv� tr✓ f�ta�o <br /> al) t !ate <br /> •'UI be <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> %A ll Check O' rst, -� "Pr o,ea =i2epd *' Correct LAND USE 4 ? <br /> Correct CONDITION(S)? Loggcd to�A, 'D USE Book? <br /> FH 06 06 Report 07201 March 21,2006 <br />