Laserfiche WebLink
NOTE: PULL ALL PERT*YwfS (SEPTIC, WELL, ETC...) ". KE COPIES FOR FILE <br /> LAND USE REPORT aU �3YS APP# <br /> EHD RECEIVED APP.REFERRAL: /0 —9 COMPLETE & SUBMIT BY ' <br /> � 'O a <br /> DATE DATE <br /> ATTN: �n/1/ �il!- Ile <br /> SITE ADDRESS: & t/6 <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 /> 0/50t, -�4t- �e mos zlwzx; is t d✓,ot0aezy �f'T ievrsA:;y-& <br /> 4.4s c J <br /> CG%!/i?�s1 �1�'-Y�fL �xYJ .rI'A�Ilri�fY.✓G"�'�IG2����571 -1�ZlPlc�K5�7%�F-�y' <br /> �tt' lolrF'NlZLl�iLrEi/.f3.E•S t�/��.[trZ�1e�.Z�.E'e�L.et'� �-+Z•?>_�'�,- 2.25 <br /> rix�?�'i'�lees {�'t�✓Xa r�r�:4z��.tLet3�reC's'r.�t/J��e,�a�--�+Ks L�?�s/?��'��/cC� <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Leeaad Senior Comments: <br /> - ¢ / <br /> LD it 0 �- <br /> B . <br /> C_ � yY: 0 .1 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: _Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />