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I � <br /> NOTE: PULL ALL PERP"S (SEPTIC, WELL, ETC...) .EKE COPIES FOR FILE <br /> LAND USE REPORT APP# 0 r, q <br /> EHD RECEIVED APP.REFERRAL: )2—A—0 COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: �I c �" <br /> SITE ADDRESS: 5_�L_�}� A 1CC(Y��P 12 r1 <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 /> i <br /> -G /eLKr-i, <br /> q J <br /> i <br /> �/l�a?-�S �x4 !�[! ✓yam/ '/�`�"�.�4.c-➢.� �-�-'u^�lf-i">`G'� <br /> 0 <br /> o- <br /> UX - g � Opt sf•� D— X20 <br /> C <br /> d: 0, a 8 �,�;, <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> 116360-0 <br /> SUPERVISORILEAD 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 />