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V <br /> " NOTE: PULL ALL PERAr-,�'S (SEPTIC, WELL, ETC...)EKE COPIES FOR FILE <br /> LAND USE REPORT APP#�L=/ .YC�� <br /> EHD RECEIVED APP.REFERRAL- �! �d COMPLETE & SUBMIT BY l Yup - _:t. <br /> DATE DATE <br /> ATTN: jp r► rng'A-y� jail", <br /> SITE ADDRESS: 16901 IV, _ Loctjs-k <br /> In completing the Land Use investigation, draw all Public Health factors on.tbe 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 /> �/W <br /> t . <br /> I recommend: Approval Denial Continuance Inspector's Signature'""' <br /> 1rF$yak*9e$s�rkxele�r�EhF9t�s�tde�i'ek$�e�rEkat9t9t�e�e'eie$** F�s9e>F�eih�r�t9e�c�cic�*$c�t�'r��ede�c�'cok�'c9t3e�c9r�e�ex�'eie �e�riexx�icicda�o<Kire <br /> Supervisor/Lead Senior Comments: 1 <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> SOA II CHECK OFFLISTa `_ .Proofread report?�f " Correct LAND USE#9 <br /> s t <br /> EN 06 06 Rei ll99x a '" ` Correct C0IYDITI0IV(S}�� ' Logged ire'LAND USE BOOK' <br />