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NOTE: PULL ALL PERILS (SEPTIC, WELL, ETC...} :EKE COPIES FOR FILE <br />LAND USE REPORT APP# P A-- () � - f S KLr9 <br />EHD RECEIVED APP. REFERRAL: L COMPLETE & SUBMIT BY �" I/3103 <br />r- <br />D E <br />ATTN: q , l , f <br />SITE ADDRESS: j-3 J, 44inL1r AA aIO nr)n <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: Public sewage: <br />SUMMARY OR COMMENTS: <br />/1a�J*+�`1]✓.iCT`' <br />� ' �.�� ��%42c r C � r►r � �� .mac ` d iet�7' <br />I recommend: Approval Denial Continuance Inspector's Signature <br />**icicxx$e9r7kdc4c**icoe****x�titdsdc�'s**aF**�Fnk*drakx*Te*'9c�r�c$c**$r�r�F�rdeJe�c9cic*3ck�ck�c*�c�e�e$e�9c�c9c9c*�E�c*3ci��c3cirir�e*3ek�roF3t9r�e�t <br />Supervisor/Lead Senior Comments: <br />SUPERVISORILEAD SENIOR APPROVAL: <br />EH 06 06 Rev 1199 <br />