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f1v6TE: PULL ALL PERI'CP(TS (SEPTIC, WELL, ETC...) IV(AKE COPIES FOR FILE <br /> LAND USE REPORT` �7 APP# 5(q -0 9 <br /> l/— 3 <br /> J <br /> EHD RECEIVED APP.REFERRAL: -5-S-01—0' COMPLETE & SUBMIT BY ✓ --2 -0 / <br /> DATE-- - DATE <br /> ATTN: ,S -r <br /> SITE ADDRESS: a 3 7 3Post;- <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 densfity, location of house, wind direction, etc.... <br /> Public water: V Public sewage: (U <br /> SUMMARY OR COMMENTS: <br /> A - <br /> a/ CS <br /> /iit S G Sf✓/ a <br /> c1hS v , o - L . N <br /> oz , az <br /> i6 Z, , oy <br /> I recommend: Approval • Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> �/ 1 ,, .� �ervvt�v�✓ <br /> V <br /> l0. ?— ///0 I <br /> i <br /> az - <br /> C _ /o ;) : o )- <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> D. /0 :� : 4 <br /> -0A H CHECK OFF LIST: _Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />