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NOTE: PULL ALL PER, .TS (SEPTIC, WELL, ETC...) EKE COPIES FOR FILE <br /> LAND USE REPORT APP# Pf4 -0 & <br /> EHD RECEIVED APP.REFERRAL: <br /> —ACOMPLETE & SUBMIT BY R /l <br /> DATE <br /> ATTN: Jo Ile' <br /> SITE ADDRESS: 01 C7 7 <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: ZZ± Public sewage: &/ f <br /> SUMMARY OR COMMENTS: Or <br /> _ <br /> �oL e s <br /> /nr�l�i�5 <br /> /l• 03 �xr�%� <br /> S�Ni✓rwr�s..Gs+.Y�e_V <br /> .22 c)) v .ass <br /> �Z. 02 Aire <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> Q <br /> CD -w. iD <br /> Gf Sc^4Y �Y JCi�6- <br /> D. art O ` J <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHUCK OFF LIST: _Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)?. Logged in LAND USE BOOK? <br />