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NOTE: PULL ALL PERM SEPTIC WELL ETC... MOLE COPIES FOR FILE <br /> LAND USE REPORT APP# PA -vgL -g09(SJj <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY <br /> SEDATE!! <br /> ATTN: 0 AJC,f l f-V <br /> SITE ADDRESS: �� �-J . '✓1 ,� �C� , , Tr�1 �� <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 /> I recommend: Approval Denial Continuance Inspector's Signature <br /> 4eic9cieie�cie�a'c�'cicac9exic�'e*�'eieie�c*a"eicicicx�cieicicieicic9eicxicicxxxicic�eicic�c�'c�'c�'ca�c�c4r�iie9c�eiricieiexieir9c9c�'c�cie�'c9ex�'e9edeX�ex4c�e�eicx�ex�e�e�e�c <br /> Supervisor/Lead Senior omments: <br /> , <br /> � • o <br /> 'l <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />