Laserfiche WebLink
Lir) <br /> NOTE: PULL ALL PERU 1'S (SEPTIC, WELL, ETC...) 1vt7::KE COPIES FOR FILE <br /> LAND USE REPORT APP## t'/-} <br /> EHD RECEIVED APP.REFERRAL: 6 A COMPLETE & SUBMIT BY r] L7 <br /> L)A:rE f DAfE <br /> ATTN: <br /> SITE ADDRESS: <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: i"' ; Public sewage: <br /> SUMMARY OR COMMENTS: <br /> / os <br /> �7> '"Y_-�„f /lf`C <br /> /' i <br /> Continuance Inspector <br /> ' <br /> 1 recommend: Approval ; Deniai— {s Signature <br /> a:exxxx�x,txx�x*x*xxx*�+xxx,txxxx***xx**�xx*xx��*xxxx*,t�,txxxKxxFxnxxxxxa,•-h x;.,�x�:x�nx�xaxxt�xx <br /> Supervisor/Lead Senior Comments: <br /> C , <br /> 1 /1 : GS act "cam .,„ate" CPQ=,ems <br /> SUPERVISOR/LEAD SENIOR APPROVAL: , <br /> D - hKO97II:113 <br /> . 6 2 OA 1I CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />