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,NOTE: PULL ALL PERP" TS (SEPTIC, WELL, ETC...) YKE COPIES FOR FILE <br /> LAND USE REPORT /] APP# <br /> EHD RECEIVED.APP.REFERRAL: Cf- _V� COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: v�e JO l/tk <br /> SITE ADDRESS: ( -(-j(,-C� �J ZCV, <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; c--.u-A711 <br /> � pp �..' � t��! '� / ✓ <br /> C.'..Gl.✓'/.��•2yhnJfa"f./��/ ".J'�^-� �/-{.,LE..�� n�..� ?Lag fc7,ccC,I•."�ok�a•••,L U•xi- <br /> d �-'. ✓� .�.,•i.cd�-diozs+-10 tx �!i Oo�eF l.�Q.l� 2..-y��i aC. / '<.-y1oa�.� <br /> v�.c.cn.rµY.t <br /> L .fir tz!;ems a�a ,tea Xa u R 6 <br /> .��."..%..Ittn.r 'L9sC d•f a'�j �0 _�,-f-fi<.v„ <br /> I recommend: Approy Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: 00 -2 a <br /> �yr "ur�2cibQ, yna•c..�+�an-��a+•i/ fgf, <br /> Zl.tV A � <br /> .>Z Gn. I W <br /> n i <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 11 CHECKOFF LIS : Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1199Correct CONDITION(S)? Logged in LAND USE BOOK? <br /> /� <br /> e'4 <br />