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♦ i <br /> NOTE: PULL ALL AlliMITS (Septic, Well, etc.) MAKE CVOIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0005882 <br /> DATE RECEIVED by EHD: January 17,2006 APPL#: PA-0500857 <br /> Referral Agency STAFF CONTACT: MO HATEF PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE& SUBMIT BY: Tue, January 31, 2006 <br /> Assigned to : EE0005366 MEDWA <br /> SITE ADDRESS: 21850 E LIBERTY RD, CLEMENTS APN : 02120024 <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: 1-2ze7>1 a Public Sewer: , <br /> NN fl) Name of System <br /> SUMMARY OR COMMENTS: <br /> 12D <br /> /� Q� f�/,� t/17ry0i1�0'c.' C7 /�' E�/.��/OPJ /•l'Y��ie ��drYJ�i�'���if.�o-� �/� s't9-7�Ga� PX�✓�r <br /> c �/._a✓cr+t c-h.� �ir.� 'r�fae �fi� �xc ..��P ��r� .GZoii. <br /> x7• <br /> /� ,O fG.z ,o<.a—-i�r. ttf� tea-, ter✓ �r _�-�<<.s�-�aczv=C �i P,r.a:/�2- <br /> �Od•'OL <br /> coq'•'Off' 4<r . <br /> I recommend: Approval Denia Continuance Inspector: <br /> -Oa ignature <br /> Supervisor/Lead Senior COMMENTS: <br /> A — No-te <br /> s <br /> 1 0 <br /> l D c7 <br /> e v2, . of <br /> � v21 <br /> �� l02 . vim <br /> SUPERVISOR/ LEAD SENIOR Approval: Date: <br /> OA II Check ON List a Proofread I eport? `'„'''�' - � �tl`” " Cdrroct LAN TISE# <br /> -,,acct( t:S )I fION(S) Logfed in LANU lJS1:Hook? <br /> m <br /> Januai 7 <br />