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TT- <br /> fEHD <br /> TE: PULLALL PER11r_-fS (SEPTIC, WELL, ETC...) i. AKE COPIES FOR FILE <br /> ND USE REPORT APP# PR -nj - 5S1 ( 01S) <br /> RECEIVED APP.REFERRAL: I I a 6 Ua- COMPLETE & SUBMIT BY <br /> DATE / ATE <br /> ATTN: <br /> SITE ADDRESS: JL4 Q F �n rr1 P v I,A rl E ' <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: 1�/o Public sewage: 4/o <br /> SUMMARY OR COMMENTS: [I / <br /> :SX r6;4 / �0;2, O N/ s'' a r�6 <br /> 4, <br /> G <br /> Noll� <br /> 1 <br /> D YtJ � d- ivY7� d f <br /> 212 .01 2A b0r- c ✓Ic .a <br /> Z2 6L <br /> I recommend: Approval Denial Continuance Inspector's Signature' <br /> *:t�a����*x�*tt��**x*xx*x**xxxxKxaxxxKKFxKKxKKx:�x*axx�xxxxxxxxxx*x�xxxxxaa, xx,�F:�xxFFx�xnxKK <br /> Supervisor/Lead Senior Comments: <br /> d <br /> 4 gag0 <br /> �uxrtev�c� .Q,u, F � O -4 ?ou/ <br /> q- <br /> SUPERVISORILEAD SENi]J�_R/APP VAL: n <br /> OA //CHECK <br /> 'LIST. Proofread report? Correct LAND USE#? <br /> E�H�0606 Rev,1/99 ! f Correct CONDITION(S)? Logged in LAND USE BOOK? <br />