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NOTE: PULL ALL PERMi fS {SEPTIC, WELL, ETC...} NrAKE COPIES FOR FILE/ <br /> ,: r <br /> w _LAND USE REPORT APP# f <br /> __ pOr? f <br /> EHD RECEIVED APP.REFERRAL: I 'OO COMPLETE & SUBMIT B -OCD <br /> DATE DATE <br /> ATTN: e,k+rnve i s4-r 0 <br /> SITE ADDRESS: a X a S ip ��i C� t1��1 vim_ _ k id2o^ <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.... 9 <br /> Public water: ^T Public sewage: w <br /> SUMMARY OR COMMENTS: <br /> I �- O / <br /> ;. 2Z,, . " hp ,��q,� ter► <br /> M Silo _-Ma,4-f h-e <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> ek��irk*ak�Fk*akkxx$ra4x*elrk�eelr�Y ek:F�F�ek�r�e9e�Fdea�e�rakde*deie$e�rie�e�ceY�r�ritir�cdr�r3eak$rix�r�r�r�¢�e�e�ci��'r�cieokit�e�'r4c�'r�F�c�'r�r�c3rfck�c �Fdedc�Eic <br /> Supervisor/Lead Senior Comments: <br /> k <br /> SUPERVISOR/LEAD SENIOR APPROVAL:, <br /> 4A 11 CHECK OF LIS 1" ,`, Pra`vfread cepa1 Garrett LFtND USE# <br /> EH 06 06 Rev 1/99 CONDITIC?N(S 7 Logged in LAND USE BUUK?g <br />