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r <br /> NOTE: PULL ALL PERIv,S (SEPTIC, WELL, ETC...) n {E COPIES FOR FILE <br /> LAND USE REPORT QAPP# �C <br /> EHD RECEIVED APP.REFERRAL: J �+ 041 COMPLETE & SUBMIT BY —0 02 <br /> DATE DATE <br /> ATTN: l n c I>g l/ -- /J <br /> SITE ADDRESS: Io 7 J 6 S . ( —/&d <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 /> — iI <br /> 0L�C41 "EsE2�C� f�S rICA1J -)t< <br /> (JF <br /> ai 'f7A.1a LL.< IAE��Ca'Y--THS AP;z44&6A/I t^ i t 1 -- <br /> Mf( �(xiS ?Iei1 fiY Tk1 jF <br /> Elkl,;) AS CrQij/4WCSTCDT SE= 0) <br /> iq -I Its , c [e)) <br /> 0.2 0 1 <br /> 1-Z ,z <br /> J <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> 06 <br /> �z <br /> 6 u� oS <br /> C ll ' a3 <br /> SUPERVISOR/LEAD SENIOR APPROVAL:- <br /> H-. �2 .03 <br /> }}^- OA 11 CHECKOFF LIST: Proofread report? Correct LAND USE#? <br /> El l 06 06 Rev 199 _Correct COND1TION(I _Logged in LAND USE BOOK? <br />