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NOTE: PULL ALLRMITS (Septic, Well, etc.) MAKE' IES FOR FRE <br /> LAND USE REPORT RECORD ID: SU0006663 <br /> DATE RECEIVED by EHD: July 31,2007 APPL##: PA-0700353 <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURC PE : 2690 <br /> LOT LINE ADJUSTMENT(LA) <br /> COMPLETE& SUBMIT BY: PAY <br /> x AN %W Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 21189 E HWY 12 , CLEMENTS APN : 02303006 59 60 <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 /> I <br /> I <br /> i <br /> i <br /> I recommend: Approval Z—Denial Continuance Inspe <br /> ignature <br /> Supervisor/Lead Senior COMMENTS: <br /> 11112 048 k'r--LdZ9Dn 0zf <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OT MCheck. <br /> FH 06 06 Report}#7201 July 31,2007 i <br />