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/V <br /> r=NOTE: PULL ALL PERN,,,�tS (SEPTIC, WELL, ETC...1, KE COPIES FOR FILE <br /> IF- --'Y <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: /V�� COMPLETE & SUBMIT BY �/) —13 <br /> DATE DATE <br /> ATTN: �s.)d ey <br /> SITE ADDRESS: ] (a 7 :5 n iff --S Y-- 2 i: Y X 66y—y .3 LIn 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 /> 01 <br /> r <br /> U <br /> F <br /> I recommend: Approval—Z Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> d r <br /> 1 .B sir 1r oxa + <br /> 4 <br /> P � <br /> r Y <br /> v <br /> x:02 <br /> o ... <br /> � s <br /> ? '- 9 197 91 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> 4Ofi II CHECK O.FF LIST ^' k: Proofread repvrr7;s ' Correct LAND USE#n <br /> b € <br /> FH 06 06 Rev "9 Cprrect CONDITIOlY(S}? °Logged frt L:4ND USE BOOM <br />