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r � <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> y' <br /> LAND USE REPORT APP# sS�2' Z/ a. <br /> EHD RECEIVED APP.REFERRAU S -Q5-q-q COMPLETE & SUBMIT BY ( " /.5-ff _ <br /> DATE DATE <br /> ATTN: nan1 <br /> SITE ADDRESS: 11_�6 5 S. i:5-wC C 6 Ln - (Akd <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.... q <br /> Public water: �j A Public sewage: I "T <br /> SUMMARY OR COMMENTS: <br /> p <br /> ✓ - ? � 6A 0 <br /> z.z.--01 <br /> c Alf <br /> ar-Yr � <br /> � . <br /> 'Irk) <br /> v o S � b3 <br /> I recommend: Approval - Denial Continuance Inspector's Signature <br /> 2 Supervisor/Lead Senior Comments: <br /> fI <br /> Cj -Z- . = �sb <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA'II CHECK.OF LIsn Proofread report?: " ` Correct LAND USE#9 <br /> EH o6 06 Rev-1/99 Correct CONDITIONS ogged in-LAND,L'SE=BOOR <br />