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I /V <br /> •�' <br /> NOTE: PULL ALL PERNIYTS (SEPTIC, WELL, ETC...) lyiAKE COPIES FOR FhLE <br /> LAND USE REPORT APP#� ✓-�- -O I - ,_.__ <br /> EHD RECEIVED APP.REFERRAL: o� b -0 COMPLETE & SUBMIT BYY 3 <br /> DATE f DATE <br /> ATTN: I-.A nn a7x([e r- <br /> SITE ADDRESS: <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 /> I recommend: Approval Denial Continuance Inspector's Signatur <br /> *************9r*�e�e�rk$rhe*71e9r$r�F�t�t�r*4tdr*4r*ie�rk*dr�c*ic*a�*****�t9t�c�e�e*ic*ak******dr*�c�rk**eirx�eF*9t3c9t9r�t�eicieieicx* <br /> Supervisor/Lead Senior Comments: <br /> 1 <br /> SUPERVISORILEAD SENIOR APPROVAL: _ <br /> DA:II CHECK OFF LIST Proo read re z ari? Cq'rreci <br /> t; f F: � <br /> Ell 06 06-Rev-1/99 a X E,,-> Correct CONDITIONS) fi ogged fn LAND USE. <br /> BOOK <br />