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R � .• <br /> NOTE: PULL ALL PERMu—S (SEPTIC, WELL, ETC...) 1V E COPIES FOR FILE <br /> LAND USE REPORT <br /> APP# f°n - ^!7 -/ g <br /> EHD RECEIVED APP.REFERRAL: `00 COMPLETE & SUBMIT BY —16 —02 U2 <br /> DATE // DATE <br /> ATTN: Ti DA MAIL t- I akr — <br /> SITE ADDRESS: NI a 5 C /7 l%il Sfre f S f 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 population density, location of house, wind direction,etc.... / el-1- <br /> / J <br /> Public water: '6 b I eVVF TC j/ Public sewage: G 1 7�� �T L 02? <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> I �- <br /> � <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1199 _Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />