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�_ rJ u-- : S a000.3Y06 PS L �6 90 <br /> RT <br /> NOTE: PULL ALL PERfiVIITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP#: PA-04-142 (LA) <br /> EHD RECEIVED APP,REFERRAL:3l31/04, COMPLETE & SUBMIT BY:_**` <br /> DATE -t Z -Y- 4/5/f/4SF _ <br /> DATE <br /> ATTN: JOHN FUN ERBURG <br /> SITE ADDRESS: 16113 SOUTH VICTORY ROAD OAKDALE <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: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> ' R <br /> I recommend: Approval X Denial Continuance Inspector's Signatur <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> EH 06 06 Rev 1199 OA H CHECK OFF LIST.• Proofread report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE BOOK? <br />