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NOTE: PULL ALL ArRMreS (SEPTIC, WELL, ETC,d MWKE COPIES FOR FILE <br /> LAND USE REPORT / n APP# � <br /> L/ <br /> EHD RECEIVED APP.REFERRAL: /0_6 -V'j COMPLETE & SUBMIT BY / ! - - Q <br /> DATE <br /> /- DATE <br /> ATTN: - Tine l g�rMP iS7c <br /> SITE ADDRESS: 29 / g / `S. /, RA M ir4 n lCd Tro,c� <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 /> c <br /> Go «, , <br /> 2 <br /> /c7 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> - - 0Y <br /> `t� -�,.-U.a� -w�� c�d4✓Jd�X'� <br /> o :o <br /> 641 <br /> 1-Jor"alia-1, 40 <br /> 02 :D <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />