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� t` _ t RB <br /> NOTE: PULL ALL Pi,. S (SEPTIC, WELL, ETC...) 1VOKE COPIES FOR FILE <br /> LAND USE REPORT APP#: PA-04-105 (SA) <br /> EHD RECEIVED APP.REFERRAL: 4/18/04 COMPLETE & SUBMIT BY: 04-06-04 <br /> DATE DATE <br /> ATTN:_ JENNIFER JOLLEY <br /> SITE ADDRESS: 149 WEST WOODBRIDGE ROAD, WOODBRIDGE <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 /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> EH 06 06 Rev 1/99 OA H CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE BOOK? <br />