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NOTE: PULL ALU-.. RMITS (Septic, Well, etc.) MAKE w4P1ES FOR FILE <br /> LAND USE REPORT RECORD ID: SU0005630 <br /> DATE RECEIVED by ERD: September 13,2005 APPL#: PA-0500554 <br /> Referral Agency STAFF CONTACT: KATHY,,4LLEN PE : 2631 <br /> COMPLETE& SUBMIT BY: SITE APPROVAL-MINOR(SA) <br /> Sept nber 2005 <br /> Assigned to : EE0005366 MEDINA <br /> SITE ADDRESS: 22025 E LIBERTY RD, CLEMENTS APN : 02120025&22 <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: j� Public Sewer: <br /> Nan�e-of Purveyor Name pf System ' s <br /> SUMMARY OR COMMENTS: <br /> �/Y/— /0 aY7 � �Js✓c c7 <br /> �''f �� � �/./�L /� L/�YI�f��L�LL ////T/�� 'l 1��Y7Yl'YJl✓/// <br /> 7 <br /> I recommend: Approval Denial El Continuance spect /�j <br /> Signature <br /> Supervisor/Lead Senior COMMENTS: <br /> S' <br /> d a� <br /> 2 2; <br /> SUPERVISOR/ LEAD SENIOR Approval: ! I �._,i -_ - Date: <br /> OA II Check Off List: rCo _.USE <br /> Proofread Report? - <br /> Correct CONDITION(S)? Logged in LAND USE Book? <br /> EH 06 06 Report 47201 September 15,2005 <br />