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NOTE: PULL ALL PERMS (SEPTIC, WELL, ETC...) r - 1KE COPIES FOR FILE >� <br /> LAND USE REPORT APP# S jj <br /> 2 <br /> EHD RECEIVED APP.REFERRAL: -t�-01 COMPLETE & SUBMIT BY 3 - 7 -O <br /> ATTN: lDATE <br /> ��n 11� /e,� <br /> SITE ADDRESS: I � 9 7 /y ��Sh.(,d t �� (' f-lcd <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 /> SUMMARY OR COMMENTS: <br /> i <br /> EXPose 4ND IASfteT- TAAvK — <br /> 0-oAlMEEi To Ciry SE f<i ikXS 45 Sooti h5 T��y 13ero� Ar,gtt-n$� <br /> A o P-K oAt7S 6u LE <br /> I recommend: Approval Denial Continuance Inspector's Signature J <br /> Supervisor/Lead Senior Comments: <br /> tDyoiaA-V—V J z a1.t/t 2 ��� A4-1) sµcxf' <br /> �LI� l�?�Lv`M.T o� dP�v ✓t.��qn�+ Prit-Q-- .QZct.��t. <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 77 CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 _Correct CONDITIONS)? _Logged in LAND USE BOOK? <br />