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lee- <br /> ' NOTE: PULL ALL PERN*S (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> Pe — <br /> LAND USE REPORT APP# .514 -0O - 10 a ppb/cam <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY ,3— 30-06 <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: % g5 --'s 6::�: ✓l� ) Gt f �3 U� <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: �'r Public sewage: 'v <br /> SUMMARY OR COMMENTS: <br /> F 1v z i <br /> f �z 0q <br /> Cr Io? � S <br /> I recommend: Approval Denial Continuance Inspector's Signature , <br /> Supervisor/Lead Senior Comments: <br /> 0V <br /> ✓ A /1: b 7 ✓ rte. <br /> : as <br /> C • ll ' Q3 <br /> E• 1 c� .oi <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA/I CHECK OFFLIST: Proofread report? Correct LAND USE <br /> EH 06 06 Rev 1/99 "Correct CONDITION(S)? Logged in LAND USE BOOK? <br />