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r4O`I'E: PULL ALL PERNtrf'S (SEPTIC, WELL, ETC...) lOrAKE COPIES FOR FILE <br /> LAND USE REPORTVV�� APP# <br /> EHD RECEIVED APP.REFERRAL: d `�-✓vim COMPLETE & SUBMIT BY 3 —/ r✓O <br /> DATE ,1DATE <br /> ATTN: J-t M P rl /v,V(C vl <br /> SITE ADDRESS: a as 1 I � -St,r X-f ,.4 _Ay P-d <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: N 0 04-- Public sewage: <br /> SUMMARY OR COMMENTS: <br /> Gld b �� <br /> ku l� <br /> /ZZ V y /^1" EfC sling -irriAa�yr uG�_ mwi loot bie rise <br /> rik Lund 44r PL4V .. UGit <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> 4.4 <br /> ,oma <br /> VW 1M'lLY, <br /> (� o3 <br /> SUPERVISO EAD SENIOR APPROVAL: <br /> E /.5: 0 <br /> OA H CHECK OFF LIST: Proofreadrepo ? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 ✓� . �� _Correct CONDITION(S)? Logged in LAND USE BOOK? <br />