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NOTE: PULL ALL PERMITS (Septic, Well, etc.) MAKE COPIES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0013529 <br /> DATE RECEIVED by EHD: August 14,2020 APPL#: PA-1700291 <br /> Referral Agency STAFF CONTACT ALISA GOULART PE : 2631 <br /> SITE APPROVAL-MINOR(SA) <br /> COMPLETE&SUBMIT BY: Fri, September 4, 2020 <br /> Assigned to : EE0000418 KITH <br /> SITE ADDRESS: 21850 E LIBERTY RD, CLEMENTS APN: 02120023,-24 <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: CLyA$2 <br /> Name of Purveyor Name of System <br /> SUMMARY OR COMMENTS: 1Rh �e ta�F9 ,,.a �il4L—V1 <br /> w <br /> I recommend: Approval ❑ Denial ❑ Continuance ❑ Inspector: �A <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> i ,5 �J ��tt�t,�Cd/'► (rZ y'(�G � ��S fit,CC.�A Sl�I�l'� <br /> SUPERVISOR/LEAD SENIOR Approval: Date: <br /> OA 11 heck Off List: Proofread Report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report#7201 August 18,2020 <br />