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NOTE: PULL ALL PERNirfS (SEPTIC, WELL, ETC...) N A*KE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: 1042De- COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: p <br /> SITE ADDRESS:,-' 1 'I 9 9 1 L����p led. , r ,4.e!�o <br /> In completing the LancT-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: Ao Public sewage: <br /> SUMMARY OR COMMENTS: <br /> J° 3o - n7 `5 •+C -IV"/ I-4/1C re—CT. c Wh �.a hrr�c4 n <br /> r w- - :s�..,.•r . .,� �/ t.ifdC� +. /� .. orhei im+nR r r 'tt -. FsM f - / ... <br /> r/ <br /> 75/"0,2, . ' 411 ✓e.,4 AY <br /> very"�v / �✓ :sp sGu.y "r iT75 . <br /> /Je rr�rei c+ncai,-na 0 S/>�QDOrd raL a7 74rS <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> a- <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST.• '_Proofread report? _Correct LAND USEV <br /> EH 06 06 Rev 1199 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />