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'NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) Ni7<KE COPIES FOR FILE <br /> ri;/�] <br /> LAND USE REPORT APP# IVIS- 9 a -q5 ;� <br /> EHD RECEIVED APP.REFERRAL: 6-Jc)-V0 COMPLETE & SUBMIT BY 7 " 3 --o <br /> DATE DATE <br /> ATTN: J,na <br /> SITE ADDRESS: 6111 d 174 /(?C/ <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 /> ZZo ;�Al tl) <br /> -h <br /> %,go- 'Now— <br /> . 2 <br /> I recommend: Approval bOOODenial Continuance Inspector's Signatur <br /> Supervisor/Lead Senior Comments: <br /> Ra �PCIY 1 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> QAII,CHECKQFFLIST; Proofreadreport� Coreci :9ND(ISK#7 . <br /> EH 06 06 Rev I/99 Correct CONDI l©N(S}R LOgged 17t LAND USE BOOK? <br />