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NOTt: PULL ALL PERK -S (SEPTIC, WELL, ETC...) P KE COPIES FOR FILE <br /> LAND USE REPORT APP# 121q a /73/GR <br /> r-- <br /> �. y sil 3�vz <br /> EHD RECEIVED APP.REFERRAL: 5 3 (✓Z- COMPLETE &: SUBMIT BY <br /> DATE DATE <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: Public sewage: <br /> SUMMARY /OR COMMENTS: <br /> (sic g;-L'40 /ta� �aB� e%' �.�:0 3 — <br /> u, e <br /> w <br /> a <br /> I recommend: Approval Denial Continuance Inspector's Signature A•�141*"7KtrD <br /> xrxxxxx*xxxa***xK**xfxK*+xK*xxxx*K�xxx+xx**KK�x*xxaaxnxxx**:�xxxx:**:�***xxxx/J*,x_*,*{,�xxx**�+**t/ <br /> ,.. . . . iF-/✓• /a-u�- ��`a6sc�.•e.� v=c��n�n�./��Xr/l.."" � ��..""w"�.. <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 11 CHECK OFFLIST: _Proofread report? _Correct LAND USE##? <br /> En 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />