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NOTE: PULL ALL PERitn'S (SEPTIC, WELL, ETC...) NrA'KE COPIES FOR FILE <br /> LAND T1SE REPORT / APP# d0A -0 <br /> 6 <br /> EHD RECEIVED APP.REFERRAL: —O� / C�OMP1LETE Y <br /> & SUBMIT B <br /> ATTN: —f- DATE <br /> P i VI i tin y 1 In/�f� , <br /> SITE ADDRESS: qJ8 3 J. /�0.✓1 iAy. y� PGI/1 K/N'GtY T�h 9� <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 /> r <br /> I recommend: Approval Denial Continuance Inspector's Signatura \ <br /> txaxaxax**x*x*�*�Kx*t,.*:�*xx:�*�*xKKxxxxxaxKx*�xxx*Kx***x��****xxx; nxKx***xx,�:txxt****,t� *�* <br /> Supervisor/Lead Senior Comments: <br /> . Q <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> F <br /> 11 CHECK OFFLIST: _Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />