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1Ll MfQCN SS <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) ftiKE COPIES FOR FILE <br /> LAND USE REPORT APP# 5/1 <br /> EHD RECEIVED APP.REFERRAL: I a -01 COMPLETE & SUBMIT BY a <br /> DATE J DATE <br /> ATTN: � g- ja r/�e� <br /> SITE ADDRESS: I I o� 9 In) L �/- Cj Tr <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 /> �- <br /> D .26 0S "46 AAW00CP1 OZI—M" A"44 <br /> INALL�c�unTE km.h �vIZ SFFTIe D�SfbSH{� KEC'or"."ev,D Pc.f3�icr .SE4�$ C3Ffof?F <br /> DE UEMPMe <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervis r <br /> O✓1 <br /> tj <br /> a)M4,. - I fdo 2 a <br /> 41 <br /> p �b <br /> Af- � Qa.-..,.f' ./ •s,�C Q.�L <br /> SUPERVISOR/LEAD SENIOR APPROVAL: /¢, /© :0 ] <br /> DD „�, lylr <br /> D. lO : ran 4 .Qocib-1� , <br /> OA//CHECK OFF LIST. Prtiojreadreport? CorreetLANDUSE#? <br /> Correct CONDITION(S)? Logged in LAND USE BOOK? <br />