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s <br /> TE: PULL ALL PERP'—�TS {SEPTIC, WELL, ETC...) �,KE COPIES FOR FILE�� <br /> C <br /> LAND USE REPORT APP# PA -0 a -36 <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY� <br /> DAT �?A�'� "" <br /> ATTN: _ J O�S-L �y� c r�n es , <br /> SITE ADDRESS: / ,r /�c(, <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 /> h t <br /> 17 <br /> I recommend: Approval Denial Continuance Inspector's Signatp.r- <br /> * <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST` - .:Proofread rep'ort� �CarreCl Lf1ND USE#9 a <br /> En 06 06 Rei 1/99.6&t Q)ND1TI0N(S)2 p Logged it IAND'DISE BQOX7 : <br />