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NOTEv PULL. ALL PERN,,.'S (SEPTIC, WELL, ETC...) r �KE COPIES FOR FILE <br /> LAND USE REPORT APP# 5P-01- 1s1 ti ZR -61-/`Q <br /> EHD RECEIVED APP.REFERRAL: /2 -4-0I COMPLETE & SUBMIT BY )�2 -_ 0'0 <br /> DATE DATE <br /> — <br /> ATTN: J_FGF F i S/lE e <br /> SITE ADDRESS: 789-2 a) LIA)Atjs� k; 7-Z9Cy <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 /> iL <br /> 17 <br /> T C <br /> J <br /> r <br /> 9 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Commegt-- _ <br /> y G: CIL z G r�i�i� ^�-^•L-� ;r o-K.Q �ox <br /> -7/% <br /> f <br /> � . <br /> `714`" i' 2G.✓�a uo t <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> PPROVAL: <br /> OA II CHECK OFF LIST.• _Proofread report? Corre=BOOK? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? _Logged in LA <br />