Laserfiche WebLink
NOTE: PULL ALL PERNIfTS (SEPTIC, WELL, ETC...) MIAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: 101 _a 0 J q / COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: _� f1 1--0 o M0, <br /> SITE ADDRESS: l 61J l m m d r U J � Izal � l)t llh c ^ <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 populationdensity, location of house, wind direction, etc. <br /> Public water: IV/ F Public sewage: <br /> SUMMARY OR COMMENTS: <br /> Cz- if <br /> p -2-. <br /> . 0 <br /> O2 _ oS <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 LANDUSE#? <br /> EH 06 06 Rev 1/99 _Correct CONDITION(S)? Logged in LAND USE BOOK? <br />