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Y <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP#: PA-03-569 S REG. APP <br /> EHD RECEIVED APP.REFERRAL: 2/10/04 COMPLETE & SUBMIT B • 3 -04 <br /> DATE <br /> ATTN: RAY H O <br /> SITE ADDRESS: 18327 EAST STATE ROUTE 88 HIGHWAY CLEMENTS <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 a completed map of area <br /> showing population density, location of house, wind direction, etc.... <br /> Public water: ">qy (,cam -__ __Public sewage: f b <br /> SUMMARY OR COMMENTS: <br /> E <br /> I recommend: Approval Denial Continuance Inspector's Signat <br /> Supervisor/Lead Senior Comments: <br /> j��4� 4*.r�AcQ la—/6— <br /> A <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> .. m <br /> EH 06 06 Rev 1/99NO <br />