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NOTE: PULL ALL P &ITS (Septic, Well, etc.) 11WIAICE O IES FOR FILE <br /> LAND USE REPORT RECORD M: SU0006894 <br /> DATE RECEIVED by EHD: December 18,2007 APPL#: PA-0700577 <br /> Referral Agency STAFF CONTACT: PATRICK CROSBY PE: 2690 <br /> ik LOT LINE ADJUSTMENT(LA) <br /> COMPLETE&SUBMIT BY: <br /> " Assigned to: EE0005366 MEDINA <br /> SITE ADDRESS: 22,460 N SIXTH ST, CLEMENTS APN : 01926047 43 45 <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: 111120yx:�P Public Sewer: /1�Y7P <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> 0 <br /> I recommend: Approval enial ElContinuance Inspector: �- <br /> Sign tune <br /> Supervisor/Lead Senior COMMENTS: / <br /> U2 Mk4—% —2C�2s� <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> SOA!!Check Off I is P aafreadvReporY? (orreot LAN1 j7SE 4 9 <br /> Corn c.t.CONDIT[ON(§) agd to LAN P iISF3aak <br /> �H 06 06 Report#7201 December 20,2007 <br />