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NOTE: PULL ALL PERNk ri S (SEPTIC, WELL, ETC...) rrfAKE COPIES FOR FILE <br /> LAND USE REPORT APP# S' -0/ <br /> EHD RECEIVED APP.REFERRAL: 3-d7"a I COMPLETE & SUBMIT BY q- 1 ( -o / <br /> DATE DATE <br /> ATTN: J C n rA ! A-f Jo(l" <br /> SITE ADDRESS: t-1 R 4 -. /6 i'Y) r r i j2 O Sct Zoe, d 4-o d—<"- <br /> In <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.... C <br /> Public water: prPublic sewage:IV <br /> �y � <br /> SUMMARY OR COMMENTS: <br /> UYI <br /> 0. jc � d <br /> f? O Z <br /> G� 3 <br /> I recommend: Approval Denial Continuance Inspector's Signatu <br /> ******,��x***��*,��,��*,�x*****x,t*:��,Maxx+��*xxx**:�*:�x�**,t���x,�* :txx*xnF <br /> Supervisor/Lead Senior Comments: <br /> D <br /> 17 OL too�or OL <br /> 14 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: r OF <br /> _ ✓ <br /> OA 11 CHECK OFF LIST., Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />