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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0012684 <br /> DATE RECEIVED by EHD: December 11,2019 APPL#: PA-1700291 <br /> Referral Agency STAFF CONTACT! ALISA GOULART PE : 2655 <br /> REVISIONS TO ACTIONS-STAFF <br /> COMPLETE&SUBMIT BY: Thu, January 9, 2020 REVIEW APPL(SR) <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: Public Sewer: <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval F-1 Denial ❑ Continuance F-1 Inspector: <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> [QA�' hk OffList: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 December 12,2019 <br />