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' T/V <br /> -OTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> � ,if <br /> EAN7b USE REPORT APP# 1-fi - 99-58 <br /> EHD RECEIVED APP.REFERRAL: -I `d COMPLETE & SUBMIT BY A,5/- <br /> DATE DATE <br /> ATTN: .Qom— sa 6-t— ., <br /> SITE ADDRESS: 1 -71 f a N �5: z,3 ��Lt e �' ��d.� _ <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 /> - -C--. rLh.6m jachori Va IU <br /> -- M <br /> t <br /> I recommend: Approval Denial Continuance Inspector's Signatur+� <br /> :k deeFx:F�t9exirIC*ic*aFitdr�r:F�ede�eke44�t+4dede$ek9e*9r 4r Yeae�tIC3e3t�dt**�***ie dck�eF-Jrafcdc{r�tieieat�evlre4de:F�e�edr�r$e*irx �e�Yde�leJeA�t�t�fckFiir <br /> Supervisor/Lead Senior Comments: <br /> � b <br /> 1.v6a- b <br /> "-ds 4 v R <br /> SliPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK.OFF LIST:.. —.,,-(-;4roofread report? Correct LAND USS#? <br /> EH 06 06 Rev 1/99 _ orrecr CONDI7"TON(S)- ogged-in LAND,USE BOOK? <br />