Laserfiche WebLink
?NOTE: PULL ALL PERAr:TS (SEPTIC, WELL, ETC...) PEKE COPIES FOR FILE <br /> 7'r n% <br /> LAND USE REPORT APP# o <br /> k EHD RECEIVED APP.REFERRAL: / v COMPLETE & SUBMIT BY ��✓�� <br /> DATE DATE <br /> ATTN: li 'lYl. VA/1. 6 <br /> F SITE ADDRESS: 6 52 F57 45/ Dore--� <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 /> w Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> N <br /> i <br /> M <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> 9e F*ae'r 9e 9e�e�c 7F 9t ie�c is xis 9c:E�c 9r�c ie de�e k�e$e kF�a'e�e$ea'reF*dr k3e�e�r�e 9e$c*9e Fc kaE do do�c fc*9r de*F�e kFx�e$r>c�'<$tx 9e 3t it�e>r�e 4eX 9ex�ex xxxxic it it iexx <br /> Supervisor/Lead Senior Comments: <br /> t <br /> i <br /> i <br /> i <br /> t SUPERVISOR/LEAD SENIOR APPROVAL: <br /> F SOA H CHECK OFF LIST z� �` Proofrear!report?'` " Correct LAND. USE V. <br /> EH 06 06 Rev �Iv9 ' , x Correct COIVDITION(S)? - ogged r►r LAND IISE BOOK? <br /> ,. . s <br /> a <br />