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NOTE: PULL ALL PERN&S (SEPTIC, WELL, ETC...) MKKE COPIES FOR FILE <br /> LAND USE REPORT APP# )- d `y/-d <br /> ERD RECEIVED APP.REFERRAL:-.2 J'-0/ COMPLETE & SUBMIT BY o? / —0 l <br /> DATE 1.,_ //£ DATE <br /> ATTN: �l JJ <br /> SITE ADDRESS: Q R :2 D 7 G✓c�MS rl D <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.... nn nn <br /> Public water: G�� tycJ Public sewage: ( I/`A sRS�-Il . <br /> SUMMARY OR COMMENTS: <br /> &�P- <br /> ;6 <br /> k ce <br /> _ W <br /> I recommend: Approval Denial Continuance Inspector's Signatur <br /> Supervisor/Lead Senior Comments: <br /> 49 ie t.L <br /> C- <br /> not <br /> SUPERVISOR/LEAD SENIOR APPROVAL: tl <br /> OA H CHECK OFF LIST.• _Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev V99 11 _Correct CONDITION(S)? Logged in LAND USE BOOK? <br />