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PULL ALL PES (SEPTIC, WELL, ETC...) 1<_-.KE COPIES FOR FILE <br /> LAND USE REPORT APP# C <br /> EHD RECEIVED APP.REFERRAL: 03 COMPLETE & SUBMIT BY <br /> DAT <br /> DATE <br /> ATTN: <br /> SITE ADDRESS: iLy <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: VA- Public sewage: <br /> SUMMARY OR COMMENTS: <br /> 6:.a a1, <br /> 14 <br /> f <br /> G c} 3 <br /> I recommend: Approval r Denial Continuance Inspector's Signatur <br /> Supervisor/Lead Senior Comments: <br /> j t/ <br /> g_ oa <br /> 0 3 <br /> SUPERVISOR(LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />