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NOTE: PULL ALL PERM (SEPTIC, WELL, ETC...) NinkE COPIES FOR FILE <br /> .r <br /> LAND USE REPORT APP# 1 O5-O I v o a— <br /> EHD RECEIVED APP.REFERRAL: I J)-- -01 COMPLETE & SUBMIT BY a ` t3-01 <br /> DATE DATE <br /> ATTN: (&Y- <br /> SITE <br /> &Y-SITE ADDRESS: 13g (Ce IfLn <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 reap of area <br /> showing population density, location of house, wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> U <br /> Il:I® 5u�f�c�/s�,g s urz �-��► R�Aa�,T RK'E�u—� <br /> 2224M TR�Tf yesr��t -- <br /> Comwl6,yT ; ' <br /> k,16%4 I- -- SEP7-1f 760 I�bRe-rt0 y o�u :5/'r& /�10&1A ILP4M PermErs O)o7- A1.z> <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> a'e*:�rx�ric4c�c******9c*9r�r9r�e�eie***�e**xnk�r**�4*ir** k*�treFedr�r*�c*4**4s 9e�cvFc*x*dr ieiciric9c*****icir**ic**ic**icdc**'rx*ereir <br /> Supervisor/Lead Senior Comments: <br /> V . <br /> C�;.; o�- <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHET OFF,LIST ,N ..' . , Proofread report?, :::a Correa LAND USE#' <br /> >: <br /> 'eorrerf eONDITIDN{,�)9 =Logged in LAND USE BOOK? <br /> EH 0606 Rev 1199 <br />