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7-T- <br /> RbTE: PULL ALL PEFCI TS (SEPTIC, WELL, ETC...)�-_.1AKE COPIES FOR FILE <br /> LAND USE REPORT APP# f g 0 -S„°l <br /> �� d2 <br /> EHD RECEIVED APP.REFERRAL: '� <br /> � COMPLETE & SUBMIT B��,. 0 ,�,. �, �_ 1�.,/��o� <br /> DA W d��f7'ATE �° <br /> ATTN: ,' <br /> SITE ADDRESS: D Lee, e-6lc-,� lcd, 114CAA -a o <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: ,/t,a Public sewage: NO <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval / Denial Continuance Inspector's Signatur <br /> �cir�kie$e�'c�'ealr�c�kx-.4x�'ekx�tit9coEdcdc9ciax�F�kk9c9:9cdckicdcirieicekx�Fie�'c9r�r�F:E�rieitdc�3eae$ckic�'rir�kdr�'e�c9t�t$c�caEicxicxieek �ek�c�k!c3edcirafrirde�FieJr�e <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> DA 1i CHECK DFF LIST Proofread report?' Correct LAND TISE# <br /> EH 06 06 Rev 1199 <br /> US. <br /> Correct CDNDITIQN(S) rLaged rn l AND B40K� <br />