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T <br /> NOTE: PULL AL RMITS (Septic, Well, etc.) MAK PIES FOR FILE <br /> LAND USE REPORT _ RECORD ID: SU0007781 <br /> DATE RECEIVED by EHD: June 22,2009 APPL#: PA-0900145 <br /> Referral Agency STAFF CONTACT: JOHN FUNDERBURG PE : 2690 <br /> MALOT LINE ADJUSTMENT(LA) <br /> COMPLETE&SUBMIT BY: ..RYE <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 21449 E HWY 12 , CLEMENTS APN : 02311014 15 27 <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: -12>-2v Public Sewer: <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial ❑ Continuance F� Inspe o <br /> S nature � <br /> Supervisor/Lead Senior COMMENTS: <br /> 24 <br /> i <br /> II <br /> SUPERVISOR/LEAD SENIOR Approval: <br /> OA f1 G�17�Ck flff LispFrespfrc ad Report�' a Cbrrect I p-USE# <br /> ' rsrect ONDITIQN{S) <br /> Lrogged m LAS <br /> EH 06 06 Report#7201 June 22,2009 <br />