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NOTE: PULL ALL PERNh:S (SEPTIC, WELL, ETC...) NrrCKE COPIES FOR FILE <br /> LAND USE REPORT APP# PA a �(731�r°1 P� a y�Ylz%J <br /> EHD RECEIVED APP.REFERRAL: 10—1 ) -0.2 COMPLETE & SUBMIT BY O — 30 -y <br /> DATE DATE <br /> ATTN: Jwe� <br /> SITE ADDRESS: C?,w o Lc k a —/fn" <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 map of area <br /> showing population density, location of house, wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> C--/r S — V�O.La,1_ lL4r� .� �im fid' certiwtGe a O a2, .t� <br /> s (� 4i► Ss c XJtt, � ,z r 44Q- <br /> 11 recommend: <br /> Q--11recommend: proval Denial Continuance Inspector's Signature <br /> ,�,tx**xKnxx**:x,v******xKKix*xx*,�xxxx*nxaxFxxs����xa�xxxx*x�x xxxx****x���FxKx*Ktt*x:v*xxxxr*x <br /> Supervisor/Lead Senior Comments: <br /> i <br /> sem" <br /> 'A-An) a.J-s-—-Co a -l3 <br /> � .0 tFY Ga1C(n .�4y a� _dLCa�r Gt3da- <br /> ni)� u- <br /> SUPERVISORILEAD SENIOR APPROVAL: /Y�m�.cZT% trst�cr ar <br /> u , <br /> OA //CHECK <br /> 'LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />