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J tf/m H <br /> NOTE: PULL ALL PERNZitS (SEPTIC, WELL, ETC...) Nkr&E COPIES FOR FILE <br /> LAND USE REPORT APP# PA --0 3 - 30 364) <br /> EHD RECEIVED APP.RE,FERRAL:D E O COMPLETE & SUBMIT BYE/0-j <br /> ATTN: )QJ) y'\1 >Ce ✓ ID I�AJ <br /> SITE ADDRESS: a 84 a a S i��t itr� hlrf d� f 1 Ute. :FCQ <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 /> � 2• ®l <br /> / 37. 01 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA /I CHECK OFF LIST: Proofread report? _ Correct LAND USE#? <br /> EH 06 06 Rev I/99 Correct CONOIT/ON(S)? Logged in LAND USE BOOK? <br />