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NdTE: PULL ALL PERT` I'S (SEPTIC, WELL, ETC...) !,-..,KE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> J <br /> EHD RECEIVED APP.REFERRAL: J Z COMPLETE & SUBMIT BY �- <br /> DATE L DATE <br /> ATTN: ' I C k— G r{ n <br /> SITE ADDRESS: 15 ,-) S u j , L-3 R(A Tr c <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 /> 4;d <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor//Lead Senior Comments: <br /> e�w -L cr <br /> i/�G�{cv /7 � --- -► � <br /> ./d .2 ; 0 2 —..L-� <br /> - z <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA LI CHECK OFF LIST: _Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rev 1199 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />