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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# O P- 16 -a (Ple0lSed) <br /> �- /v9�� y� p <br /> EHD RECEIVED APP.REFERRAL: TE (9� COMPLETE & SUBMIT BY P/ <br /> l`7�� -ao- 99 <br /> DATE DATE <br /> ATTN: l �- o A <br /> Gl C fi �' , <br /> SITE ADDRESS: d� le �� G e" <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 /> o 7r <br /> (�:U� — (KEPI�fFGE ra�oKD �MP�oyL-ES w�rrr woRn S�A-TS <br /> 22: U2 <br /> I ecommend: Approval Denial Continuance Inspector's Signature <br /> * «��+.��****,��***�*****�*�r.**,�**.�,�:rx:���*��+,�*�****,•.*r.�*****��,��****+,***ter.********��:��***� <br /> pervisor/Lead Senior Comments: <br /> A ! o <br /> � o � <br /> c S P3 <br /> D � <br /> 2+� p <br /> 7. /5 , 10 ) <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> DA II CHECKVFFLIST.• ProofreadI report Correct LA AID USE <br /> EH 06 06 Rev 1/99 Correct CONDIT/ON(S)? Logged in LAND USE BOOK? <br />