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Z6 <br /> NOTE: PULL ALL PER *rfS (SEPTIC, WELL, ETC...) NA.1KE COPIES FOR FILE <br /> LAND USE REPORT APP# Sl�l— O ( — .�3 <br /> EHD RECEIVED APP.REFERRAL: �� 8� COMPLETE & SUBMIT BY g�— X22 is <br /> DATE I� /� 1_ DATE <br /> J <br /> ATTN: t,,m)i A- _ �JU I I QM <br /> SITE ADDRESS: qLC�. , �7�r�G, l.,QiJ !� . , /YI lii ylCCGI <br /> In completing the Land Use inv shgga If onA %ublic 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 C NTS: <br /> c r <br /> 44 Af <br /> c42 <br /> r <br /> AO e14- <br /> Ir <br /> dq 4f <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> as o — <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> Eli 06 06 Rev 1/99 Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />