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f'h <br /> NOTE: PULL ALL P%,JITS (SEPTIC, WELL, ETC..,) AKE COPIES FOR FILE <br /> LAND USE REPORT n f <br /> APP# <br /> COMPLETE FHD RECEIVED APP.REFERRAL: COMPLE <br /> / TE & SUBMIT BY <br /> DAT <br /> DATE <br /> ATTN: J U �J 1' G, V1 PS <br /> SITE ADDRESS: 2 2 v-q. 3 5 YVl P-c c _ <br /> In completing the Land Use investigation, draw all Public Health factors onthe exhibit (is age disposal, <br /> water supplies, etc...). Where necessary, on an attacbed piece of plain paper, draw completed map of area <br /> showing population density, location of house, wind direction, etc.... <br /> Public water: <br /> Public sewage: <br /> SUMMARY OR COMMENTS: <br /> W'� �JQ <br /> I recommend: Approval f Denial Continuance Inspector's Signature: +,i -t'/ '1 H <br /> nspect is S g atu e: K`x tn'J' <br /> Supervisor/Lead Senior Comments: <br /> 11 4 G yam'+- 44° <br /> aj- Q2 <br /> _ - _ s Owe-o✓ao <br /> L r' - I S. . <br /> SUPERVISOR/LEAD SENIOR APPROVAL: Q - <br /> D. 1�: o3 <br /> _ OA I/CHECKOFF LIST.• Proofread report? Correct L,9NO USE#? <br /> "EH 06 06 Rev 1/99 <br /> • 2 PJ14�I Correct GOND/T/O:V(S)? _Logged in LAND USE BOOK? <br />