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r <br /> NOTE: PULL ALL PERNtrfS (SEPTIC, WELL, ETC...) NMKE COPIES FOR FILE <br /> LAND USE REPORT APP# PA - 03 -j ?(1d'15 <br /> EHD RECEIVED APP.REFERRAL: '3 1 -C3 COMPLETE & SUBMIT BY <br /> DATEDATE <br /> ATTN::: -J Cde- eu L l a n`es <br /> SITE ADDRESS: /-�/ 96 E• \, ja A//1 / da, k2p <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: /10 Public sewage: /xj <br /> SUMMARY <br /> /OR COMMENTS: <br /> C> ,Y <br /> C �/ "O 3 - Tei ir• .-i -� �� � -s� .�, / .r�i�6r.�- <br /> I recommend: Approva Denial Continuance Inspector's Sign�ttCr <br /> **:�x**+*n���+:�**x*�xxxxxx�x,�*��*,�**���*x*�x��**:�*���*�+xx**x�xxxx*n�K**x:�m*x��xxxx• xxxx,�x <br /> Supervisor/Lead Senior Comments: <br /> 0 / � <br /> sintSt t�^s�e� q F <br /> r f <br /> g Ta - dam �, i ✓ <br /> D a� 0 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />