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NOTE: PULL ALL PER1PriTS (SEPTIC, WELL, ETC...) a.[AKE COPIES FOR FILE <br /> LAND USE REPORT APP# daaca <br /> VV <br /> EHD RECEIVED.APP.REFERRAL: -29 COMPLETE & SUBMIT BY—_q — / - / 7 <br /> D TE I f �� <br /> DATE <br /> ATTN: l /(//` <br /> SITE ADDRESS: yt3/n 6 �C 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 /> r 1 _ <br /> ki <br /> � � '.C�fC'.IY1/`—' /,S AYYXA-�^"'""'1 T� l�Ol/l�_r.M .�i��Av✓) _— <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA !I CHECK OFF LIST. _Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rev 1199 _Correct CONDITION(S)? Logged in LAND USE BOOK? <br />