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MOTE: PULL ALL PERTS (SEPTIC, WELL, ETC...) r�`AKE COPIES FOR FILE <br /> LAND USE REPORT APP#Pa-03 -q e <br /> rxn Rrcerven APP.REFERRAL: 02 COMPLETE & SUBMIT BY <br /> i DATE <br /> ATTN: <br /> SITE ADDRESS: Q-5cR 9 L:/1zr& <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit (i.e.: sewage disposal, <br /> water supplies, etc..). Where necessary, on an attached piece of plain paper, draw completed neap of area <br /> showing population density, location of house, wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> P -f�r.r �C 1 s f .YI C f�QM 1A) 4"U <br /> I recommend: Approval l/ Denial Continuance Inspector's Signatur any <br /> ***is************9to'r�eJe�e*de*dc*ic****de*atx�r�e*$e JrFiv**********kvEF**'c*'ciexirieiexx**itis***oFir9<F*�cxk*nFir*ac**$t <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST <br /> report? <br /> Correct LAND tJSE#9 = <br /> EH 06 06 Rev 1/99 r, -t om '.'correct CONDJTION(Sf ' Logged 61 LAND'USEBOOK? <br />