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.� l 'OTE: PULL ALL PERTS {SEPTIC, WELL, ETC...) ± t'KE COPIES FOR FILE <br /> LAND USE REPORT APP#_ PA -OP, -93(01) <br /> BYEHD RECEIVED APP.REFERRAL: �'Q0-09— COMPLETE & SUBMIT BY "Sp � L 0-a— <br /> DATE DATE <br /> ATTN: K M <br /> SITE ADDRESS: S a <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 /> r <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> b <br /> / 141WTa <br /> I recommend: Approval )( Denial Continuance Inspector's Sign <br /> de�Fde:Ede*�ek�c�c�e�tE:Ede*�F3cdc�dcoEvkk$e:EaE�3c�e9c!eaF�c�t�F9t�lrit9ta'e�r�exx�'r�e�eJexxxieirxirxx$'$e�'t$r�riex7e�'e�kx ,� x�ex �ex�'e�YdeJratiielririede�c <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> a <br /> OA II CHECK OFF LIST " praojread report? Correct,LA)VD USE# <br /> EH 06 06 Rev 1199 �` ' y€�'Correct CONDITIONogged in LAND USE BOOK? <br />