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NOTE:. PULL ALL PERI TS (SEPTIC, WELL, ETC...) kKE COPIES FOR FILE jy <br /> a . 1.00 /1 <br /> LAND USE REPORT l APP# t�—� <br /> EIID RECEIVED APP.REFERRAL: -d- "b I COMPLETE & SUBMIT BY �— q —'0 (`d <br /> DATE DATE <br /> ATTN: �nn <br /> SITE ADDRESS: 1 01 1 �`a(�J�'e- r L—A ; <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 /> AR3A <br /> 2Z^� /^ 1 ic'K t p �n p �MoJt u2NED (r' <br /> o / — 140 UE d//fP K u/4.c UE To eFTL- 66AI T IIArm "e-4L <br /> }flab? TD �iAillt 1�ee4lp_ xiT 5&04) Ung 960f5E4P <br /> RE- 4 R I,EAC/1- E /f 1eE 4J1� IC•��o <br /> JzE 7e c��— <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> r <br /> 1 OL <br /> C!D <br /> — O .J <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST., _Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rev 1/99 11 ,_,Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />