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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE ' <br /> LAND USE REPORT APP# - 77 <br /> EHD RECEIVED APP.REFERRAL: V— •-99 COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: 5 7 yD 0 5 ,-- <br /> In <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 /> r �A <br /> v <br /> a <br /> 92- ,C) <br /> 7 .az <br /> c- 92.*a?> <br /> f <br /> A groundwater monitoring plan is to be submitted to the Environmental Health Oivision <br /> 1 for review an approval. The plan needs to address overdraft, flow patterns, and possible <br /> changes in groundwater quality. 'Environmental Health will charge for review and' <br /> permitting as deemed necessary. i <br /> I recommend: Approval Denial Continuance Inspector'sSign ure <br /> ** ***** <br /> Supervisor/Lead Senior Comments: <br /> oa <br /> _ n3 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> 0A11 CHECK OFF LIST: -,. Proofread report? Correct LAND USE ? <br />` EH 06 06 Rcv l/99 Correct CONDI'TION(S)?' .' Logged in LAND USE BOOK? <br />