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NOTE: PULL ALL PERNI.1'S (SEPTIC, WELL, ETC...) NitiKE COPIES FO]Z FILE <br /> LAND USE REPORT APP# -54-0o- fid' <br /> EHD RECEIVED APP.REFERRAL: IQ -'{'00 COMPLETE & SUBMIT BY 1 - 9 -01 <br /> DATE nn � J1 DATE <br /> ATTN: J e i - � isAe r <br /> SITE ADDRESS: 721 S . Dm ;,!-L (Ge igo e S J_-z V <br /> In completing.tbe 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 /> u <br /> I recommend: Approv Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> jO <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECKaFFDIST Prgofreail report? K,, Correct'LAND USE#?. <br /> EH 06 06 Rev 1/99 a'u 3, S CD meet CONDIT70N(S ; k9L77 <br /> ogged in LAND U.SE B041i? <br /> sy <br />