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KCS <br /> NOTE: PULL ALL PERA`S (SEPTIC, WELL, ETC...) T.KE COPIES FOR FILE <br /> LAND USE REPORT APP# , 4-00-k/ (TE ) <br /> EHD RECEIVED APP.REFERRAL: ' COMPLETE & SUBMIT BY - 73 --U <br /> DATE DATE <br /> ATTN: �, i /1 t /Yk)e ISN <br /> SITEADDRESS: C�y-r �.� �,�1.k ��d 1 ✓C-Gv <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 /> I recommend: Approval Denial Continuance Inspector's Signature <br /> *K�Yx�x�xxKx�:�Kxxxx*x*x**xxxY*xxxF, r:�K***xxx***�*x**xx*x*K�x�xx�xxnxxx:�xxx�*x*;xxxKxxx*x�x <br /> Supervisor[Lead Senior Comments: <br /> Wo <br /> SUPERVISORILEAD SENIOR APPROVAL: L 'r <br /> OA II CHECK OFF LIST. _Proofread report? _Correct LAND USE t!? <br /> EH 06 06 Rev 1199 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />