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',J' NOT : PULLALL PERMT'-*"3 (SEPTIC, WELL, ETC—) P,''-AxKE COPIES FOR FILE <br /> LANAI USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: J -1-0t , COMPLETE & SUB I4)0 1 V L64�Ar <br /> /a 701 <br /> DATE DATE <br /> ATTN: —.SO__ <br /> SITE ADDRESS: 2S f Tr�,G <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 /> �S110wiIlEnanul �t�g���vAlncatinn nf_hn��.cP wi.nr3_r3i.rPrtinn_.atr� <br /> t <br /> O Legal agent(attach pmol of the owner's consent to the application of the property's involved In this application and <br /> i_ _ _.�_�__�..__c,_ .nnd-that the t`oreuolno aoullcatlon statements are_true and correct. <br /> SUMMARY OR COMMENTS: <br /> F I- cC-C- E z O. <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> eie*:irx*Pirie*fie*�r*ic*vc*�'r�r$efe*fie*$sic**nkir�rx**:ir�ex*�rF9rvF�ttFIcyF9caE*vF*ds****ie 4e* kk�'e�c9r**iEi*�t�rie�e*9c*ic*$c4*ie�ei��r�e*ie*** <br /> Supervisor/Lead Senior Comments: <br /> 0 <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST Ptaofi ead report? Correci LAND CI.SE#' <br /> EN Qb 06 Rev 1199 9 <br /> 4' Crsrrect CONDITION(S)7 g Logged in LAND USE BOOK <br /> M„ <br />