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ti <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) M,.ACE COPIES FOR FILW <br /> LAND USE REPORT APP# P 4 ^ a g r 6 7(C/?) <br /> V <br /> EHD RECEIVED APP.REFERRAL. <br /> 9 .0 0Y- COMPLETE & SUBMIT 9 l <br /> ATTN• TE ' ` y oe l I Q- r DATE <br /> SITE ADDRESS: QL,2, �- <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 /> Gly/ Glomi —� <br /> 7/IS !� 1 <br /> � 3l <br /> • r� <br /> • .�li �G �.t��l /7 <br /> I recommend: Approval ill Denial Continuance Inspector's Signatu <br /> xx xxx x�e hvE do to�'txxxxir'xx�exxxxdr aF�xFexxxxie 4e$exxxxie is•t ie it ix de ie do 4t$exxx�r*xdoxxxxir k$s*xxx*xdexx exixx xxdr iexxvFxxnFx <br /> Supervisor[Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> '..FProo read re ort ` '§ ''xCorrect L:92YD lISE#9" <br /> OA II <br /> Ell 06 061tev 1199 Correct CONDITION(S)?,!, Lagged rn L,4ND;USE BOOK <br />