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1 . <br /> JH <br /> NOTE:' PULL ALL PERNMS (SEPTIC, WELL, ETC...) NMKE COPIES FOR FILE <br /> LAND USE REPORT APP#: PA-04-88 (SA) <br /> EHD RECEIVED APP.REFERRAL: 3/10/04 COMPLETE & SUBMIT BY: 3/31/04 <br /> DATE DATE <br /> ATTN: JOHN FUNDERBURG <br /> SITE ADDRESS: 2405 EAST STATE ROUTE 132 HIGHWAY, TRACY <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: /1Public sewage: -r <br /> SUMMARY OR COMMENTS: ` <br /> rDZ -D1 - -D -D <br /> recommend: Approval Denial Continuance Irector's Signature <br /> *�c�FxxY�Y�Fx�c*Y>c***4c�c�F k E Y*�k 3c***xxxis is 9c�F aF'xz�c 3c nFzx�C�F 9c*�c�c�c* * �e* * *$r nF�c ic'xxxx*ic*xx�cxxc is icz�Fxicxir�F ,: <br /> Supervisor/Lead Senior Comments: <br /> Y01. <br /> i f • O . ' 0� <br /> IV <br /> GQ <br /> i <br /> 18 , 4- <br /> C� : n 3 <br /> d a : D <br /> S PERVISOR/LEAD SENIOR APPROVAL: <br /> 10 a G,T <br /> �6 D 6 OA II CHECK OFF LIST.• Proofread report? Correct LAND USE#? <br /> EH 06 OB Rev 1/99 G. <br /> 11 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />