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Poll ( tt ,w T'' <br /> NOTE: PULL ALL PERIVI,✓S (SEPTIC, WELL, ETC...) N,,,/KE COPIES FOR FILE <br /> LAND USE REPORT APP# SA—Ol q —75 <br /> EHD RECEIVED APP.REFERRAL: S �aC -60 COMPLETE & SUBMIT BY_—j <br /> DATE DATE <br /> ATTN• 1{ n rr.{ <br /> SITE ADDRESS: 15 Ll 'N 1� l —o wt-11 SaC�arra.I-J IC-Q <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 /> nn I 1,202 <br /> C- G✓ ' l //II fid- '�° Ula t 5� G 5�. <br /> 11 <br /> 41V IZr, r7>I /IGY�'IP/Di le DYpG✓ �U /SSGftfi>'7C� d l'JLtt �di✓7H <br /> Pr <br /> plca /� 6n ori- aDp/i" irfiol� Ad�� ��>oOD <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> � y <br /> AA <br /> c <br /> a <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: _Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />