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S <br /> NOTE: PULL ALL PERNhTS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT I - <br /> APP# 4 -03-1/k( X7 <br /> EHD RECEIVED APP.REFERRAL: �/J COMPLETE & SUBMIT BY l —1S — 03 <br /> DATE DATE <br /> ATTN: e) C)IIP A <br /> SITE ADDRESS: pYl 1 I-/yyX led ' ' Lll l a4-. <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 /> !=/GcA1tyzl� . x� l2t!!!�-1 <br /> TIS—//flsi /�'19-iC�P/'Ty G�Tif�i1ck�2Z`i'C2:r/�SI� �i'dd/w.��.d?D5 <br /> zaE /,2llir6d7•cJ! G/ffj 2z cc—, <br /> iib" �..r�Din�F T�r�u�J.E�G.fi�sc��cfs�irdPr�T��"'��l ifs •4 <br /> s='c''C�4I7.�1/Jl`ll�Tv�" ,ll/1 C�iit�"�cn!S <br /> I recommend: Approval ✓ Denial Continuance Inspector's Signatu <br /> Supervisor/Lead Senior Comments: <br /> A�> <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <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 />