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t,. <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: `1 q -qq COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: i L t1 O M a <br /> SITE ADDRESS: 3_ A C0+4-ft SkA - <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: G <br /> Ot5 73`C-- <br /> r oVQ cT*& <br /> 'Z Z rrrl c p P P[�rrA�'r S �L r,A K F AP9Gt cA-Tf p�"7� x ,2.4 rT yQ <br /> Ifs(JY ` 1 <br /> v,=5,6@yi Cir .�1 EG�iori i�rGE /� �ue— A Yr o6'e? T TC 1=00'e,047:6 A <br /> Gtr ,5 STS'`! r/�1�J r�vi5�yo��i c <br /> ay... -:SAA 4>v sr <br /> AEY� PP T TITLE Sr-G�^;K G -11 za- Z -1— J I IS. Q <br /> I recommend: Approval Denial Continuance Inspector's Signature /_ <br /> Supervisor/Lead Senior Comments: <br /> Mo <br /> SFr, <br /> r. <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: Proofread repoit " orrecYCAND.UISE#9 <br /> EH 06 06 Rev 1199 orrecz CONDITTOIY(S)9 �ogged i►I L,4ND USE BOOK <br />