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rjI11/leJ <br /> NOTE: PULL ALL PERI,,,, rs (SEPTIC, WELL, ETC...) . EKE COPIES FOR FILE <br /> LAND USE REPORTQQ�� APP# PA- -o,� - G 3 �) <br /> ,fl <br /> EHD RECEIVED APP.REFERRAL: I9 bZ-- COMPLETE & SUBMIT BY <br /> DAT <br /> ATTN: � i k -) DATE i (h.� <br /> SITE ADDRESS: -7 6 S }� �}S ,C 2 dT t'r, - // <br /> cf- U 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: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> 'Llve- 6-,'\ a,- <br /> k kk1 'a�vQcetirk 1 a�C t tori is �u, �c� n\d <br /> r <br /> V <br /> J <br /> dd <br /> I recommend: Approva Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> G y I ( , <br /> 14 , <br /> 4 � r � - <br /> f aC4� <br /> a - <br /> 03 e—ad- <br /> t - <br /> 1SUPERVISORILEAD SENIOR APPROVAL: J <br /> -Kp Xj,tc. <br /> {o OA H CHECK OFFLIST. _Proofread report? Correct LAND USE#? <br /> E Rev I/99 Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />