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NOTE: PULL ALL PER11vr17S (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT , 3 `l � <br /> APP# /7i4- - o <br /> ryc m1 <br /> EHD RECEIVED APP.REFERRAL: 1 V� u COMPLETE & SUBMIT BY LU - 9 " U a <br /> DAT DATE <br /> ATTN: <br /> SITE ADDRESS: 2 go S <br /> In completing the Land Use investigation, draw all Public Health fac rs 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 /> /377o-Jr/tel GZ^�nZ S 171-AC-1 2- <br /> • L/3►/1 ts�ScT.P�-7q.SrI.�/l?�LD//1.Y.L��$Jn�/.�'T��7�isfd�7.7X/J!/�7tn K�r� <br /> • //; 02/!/.'03=_1�OGF�s.s��[t� �/G 5�J 6rrsc •�/tic--�'/l�ic«�2�-� <br /> ' ;oS <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> SupervisorVd Senior Comments: <br /> D <br /> A. 0 ; 0 .1 <br /> 47 j <br /> n✓ <br /> 2o • os— <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA I/CHECKOFF LIST: _Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />