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NOTE: PULL ALL PERI I'MS (SEPTIC, WELL, ETC...) N --KE COPIES FOR FILE <br /> LAND USE REPORT APP# (�l� -0 3// 1`�(SA � <br /> EHD RECEIVED APP.REFERRAL: "1 6 COMPLETE & SUBMIT By—j-.- J v— 03 <br /> DATE <br /> DA <br /> E <br /> ATTN <br /> SITE ADDRESS: J.3o I� )J h.v�Kr n n `2d �P I►^e <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 /> I71;v af0 1� �ro�- �.�s �.,•r- o\ �\sy\.o� re..4Ta-9o�{�Jr.� <br /> �� A► c�t�er �,x„ o,� �'ww\ pye, ;&-k% Wv�>� V s4 ,T-U, cXA-j— <br /> _oYltcr•n � v �_ CK� S(�, <br /> ,6 <br /> I recommend: Approval Denial Continuance Inspector's Signature m <br /> pdu <br /> * <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST.• _Proofread report? _Correct LAND USE#? <br /> EF106 06 Rev 1/99 Correct CO:VDITION(S)? Logged in LAND USE BOOK? <br />