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NOTE: PULL ALL PERI T SSEPTIC WELL ETC C...) M�E COPIES FOR FILE <br /> LAND USE REPORT APP#_ 01+ `0 3 -aI`S/g <br /> EHD RECEIVED APP.REFERRAL: `� Q COMPLETE & SUBMIT BY o� "` 3 - 03 <br /> D4E <br /> DATE <br /> ATTN: V0 OP-((e C <br /> SITE ADDRESS: p CQ <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: ,,a Public sewage: <br /> SUMMARY OR COMMENTS: <br /> A e �i� L kyr+ `l I reta� e d c.� <br /> n <br /> a � <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> 9c�c*�E is*de is kir ie�e$is it ie ie e�exx�kk*de afe ale n�ex K�c�rK�c�eK�e�r$r 9e��'t�r*�F��t 9e 9r 9e�E k�c 9e k�Y�c kic ic-Jc iek�i is�c it it is ie�c i�ir is�i ie ie ie Je ie ie is it is�c it.'cx�c <br /> Supervisor/Lead Senior Comments: <br /> 0 F V10 . <br /> 0, 4 <br /> - e-• 1 l , d r 0-J-d t r -- <br /> - aj-o - on <br /> a,,ly <br /> . Y4Z �� <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> O <br /> 0411 CHECK OFFLIST `' .. :PraoJrepd reports Correct LAND,USE#9 <br /> EH 06 06 Rev U99 r = Correel CONDITION(S)7 Logged in LAND USE BOOK7 <br />