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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0012683 <br /> DATE RECEIVED by EHD: December 11,2019 APPL#: PA-1700291 <br /> Referral Agency STAFF CONTACP. ALISA GOULART PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE& SUBMIT BY: Thu, January 9, 2020 <br /> Assigned to : EE0000418 KITH <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: k 0 W Public Sewer: <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: ��S _ 7D 18 <br /> WIN <br /> k\(2A(,LD t�7 <br /> I recommend: Approval ❑ Denial F] Continuance ❑ Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> A II h k Off List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 December 12,2019 <br />