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NOTE: PULL ALL PERM: S (SEPTIC, WELL, ETC...) 1KE COPIES FOR FILE <br /> LAND USE REPORT APP# 1019- 03 - 9. 70 <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY //7/� <br /> DA DAT <br /> ATTN: f' 66' <br /> SITE ADDRESS: g 1Y !5 6 . 51- 1 �L <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: r > <br /> SUMMARY OR COMMENTS: <br /> dy <br /> -03 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> ttkirdcaEicickic3cicicdric�ric-fc3c-Jca�ririrxirsv*ir*kaF9ckicE$c:Ea�c�cdc9c�e9t�t9t4ea�r4e9c4ek3r9cEicdc$sk$skvEic�c9cicEk$t�tir�t�F�c9t�9c3t$t�e9ck�e �ck'ck�rie�eir <br /> Supervisor/Lead Senior Comments: <br /> r <br /> Gr <br /> { <br /> yy 6 / - <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> 1 <br /> OA II CHE.CIC:OF14 LIST ,,Psaofi6d report? Carreet LAND USE#?. <br /> EH 06 06 Rev 1199 .Correct`CONDITION(S)? :" d ogged M LAND USE BOOK? . <br /> r <br /> F> <br />