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NOTE: PULL ALL PEIb, FS (SEPTIC, WELL, ETC...y"W. AKE COPIES FOR HLE <br /> LAND USE REPORT APP# 511-01-4)- I <br /> EHD RECEIVED APP.REFERRAL:3—' a COMPLETE & SUBMIT BY - 3 -0/ <br /> DATE ,/ I DATE <br /> ATTN• Jf 1— - t Syz- <br /> SITE ADDRESS: 02 O e 9 S • <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: q <br /> ? <br /> L-/KY 2•�.r-c✓ "�rtC.Rf �i4'.]ACy � / d <br /> 44d iJ�tihu �� d rata J"d+►- A�/�®Burt ui!! kjfe- <br /> �!v o ZF�t�► bw�. <br /> . I'F IIJ�-I.L- 15 �VIF E D��MiSTPi�T1lL�/ C17K U•�t � I,�. �A ire t; , a-,c,[� ,AiS�'t r,.✓i 131' <br /> I recommend: Approval Denial Continuance Inspector's Signature 5b" T a's� <br /> Supervisor/Lead Senior Comments: <br /> w � <br /> • <br /> SUPERVISOR/LEAD SENIOR APPROVAL: �S <br /> C- . 7P.), : 0 <br /> 3 OA//CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 0606 Rev 1199 �� �� Correct CONDITION(S)? Logged in LAND USE BOOK? <br />