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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0004735 <br /> DATE RECEIVED by EHD: December 07,2004 APPL#: PA-04-727 <br /> Referral Agency STAFF CONTACT: KATHY ALLEN PE : 2622 <br /> SUBDIVISON-MINOR(MS) <br /> COMPLETE& SUBMIT BY: Tue, December 21, 2004 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 17559 E LIBERTY RD, CLEMENTS APN : 00909008 <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: '-;;'�D Public Sewer: <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> V� <br /> /i Ul <br /> as �a <br /> ��. <?3 <br /> I recommend: Approval CrDenial El Continuance Inspe or: <br /> Sign tore <br /> Suoervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA 11 Check Off List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 \ \����Iril page I December 13,2004 <br />