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SS <br /> PLATE: PULL ALL PERMIT- (SEPTIC, WELL, ETC...) MSE COPIES FOR FILE <br /> us E <br /> LAND USE REPORT APP# p14 -0 2CTyn J <br /> EHD RECEIVED APP.REFERRAL: I — 11— 02, COMPLETE & SUBMIT BY 1 — ,30 <br /> —�a <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: 3 S 17 ) ��L �`Ly✓ n '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: Public sewage: <br /> S MMARY OR COMMENTS: <br /> 22 A�tf-�- Ceahr>Puc11c 1 r3F vAT?g- KIEV, • Z�f& 111AW-4 <br /> I recommend: Approval V Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> o. <br /> C . a;L :oy <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 1!CHECK OFF LIST. _ Proofread report? Correct LAND USF,#? <br /> EN o6 06 a Iro9 _Correcl CONDITION(.S)? _Lagged in LAND USE BOOK? <br />