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AOt-E: PULL ALL PE i S (SEPTIC, WELL, ETC. ,�'` KE COPIES FOR FILE <br /> LAND USE REPORT APP# M S-0 <br /> Ell])1I CEIVED AN'.Rr.FERJUL: )0-;23-0/ COMPLETE & SUBMIT BY <br /> DATE f DATE <br /> ATTN: Y� _ <br /> SITE ADDRESS: ISY7', 99 i <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 /> k <br /> -At dy6,-' fjv-yVe1 lelwoIA4 7/1 -Y <br /> • <br /> A0; <br /> f <br /> a 8 �p Ca dry �A i� <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> *�C��C�C�C fc�:�C]�::�'11e]�[�i]�C 1�i]�C•�i]�[]�L�:i�f'�C i�f iE�C]k�C i4t iC aY*]IC iE i�C]�G iC�[�C iE*ifC ik]tC*iE�C�'it'�C int 1�C itC i�C 7�C!�C�[�'1�C]i[]fit�*�]F]��f�C�[1�C�1�C�[]�C�]�C�']�]�[�i'�C]�C]�C�G'A']k'1f k1�C i�C iC <br /> Supervisor/Lead Senior Comments: <br /> Q <br /> d :0 DL �t 1 <br /> Y <br /> �J <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA�l CHECK l�FF LISA Proofread report7s ="Correef <br /> EH 06 06 Rev 1199 ;�3,` � CorreC!CONDITIDN(3)7 LaggerCin L,4ND USE.BOOK? _. `; <br />