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L <br /> ' NOTE: PULL ALL PERK,.,,S (SEPTIC, WELL, ETC...) A,.;KE COPIES FOR FILE <br /> LAND USE REPORT APP# Q —d j? <br /> l <br /> EIID RECEIVED APP.REFERRAL: I 6-V� COMPLETE & SUBMIT BY j — 1 Y - CMZ <br /> DATE DATE <br /> ATTN: lle <br /> SITE ADDRESS: <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: ,�7o Public sewage: <br /> SUMMARY OR COMMENTS: <br /> 9L ll- jJ�h hl ( l �r ✓/l b�1 RY Y r - / <✓ <br /> �� O� S-Li✓ /J l /C%`l. i'!L ri-� /rid/ CTvi lJ�i// /Y/!� �:l - <br /> 0-el ,a- yen <br /> / V VP / / <br /> rrI <br /> 77:-'; i ._cam-c/L�1 ,.. 7-7: t. .c <br /> 1 recommen Xpproval�benial Continuance Inspector s Signatur ,/ <br /> Supervisor/Lead Senior Comments: <br /> oy <br /> Of `1, <br /> yt, 46 aea-uad <br /> ell, <br /> a. t <br /> -�'�-to ✓� �y,.e,,,.i,a,.�, /�,�.e�r,oa� � �a- �-s�.'r , � ,�.Ze4a <br /> cA,•'t .w.�'_✓ ` S c�'O`�hrCU-�.�yr C'A`- ✓ -"- . ,l'� v,../f try ..G1.(q /PI.�7 <br /> C 22 - ox <br /> p !/ • aS <br /> SUPERVISOR/LEAD SENIOR APPROVA • <br /> 4 3 0 � <br /> [OA 11 CHECK OFF LIST. Proofread report? Correct L,4ND USEV <br /> EH RAN 199 _Correct CONDITION(S)? Logged in LAND USE BOOK? <br /> J 0 --- — <br />