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NOTE: PULL ALL PER&. .TS (SEPTIC, WELL, ETC...) . AKE COPIES FOR FILE <br /> LAND USE REPORT APP#0,4 - D <br /> EHD RECEIVED APP.REFERRAL: 1 7/0 L COMPLETE & SUBMIT BY o� — I j -0 a. <br /> DATIF <br /> yj� DATE <br /> ATTN: �pz� — U � JO//P V <br /> Q <br /> SITE ADDRESS: of 30-] t , ('��n(7 mC !zy . , (�P <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: /20 Public sewage: /70 <br /> SUMMARY OR COMMENTS: <br /> GY <br /> ":3-- <br /> I <br /> Zfl <br /> I recommend: Approval Denial Continuance Inspector's SIatu <br /> Supervisor/Lead Senior Comments:/ <br /> Q 7 <br /> 1 <br /> eLejz h*C-, 2a ; oS <br /> � o <br /> ( ; A 4-11k haw±gq Y4 #j <br /> VV <br /> a <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 77 CHECK OFF LIST: _Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev "9 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />