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L-6 <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) NrAKE COPIES FOR FILE <br /> LAND USE REPORT APP# () Pv a I-0 6 <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY J I <br /> DATE DATE <br /> ATTN: ja t I-C4— -�o((&v <br /> SITE ADDRESS: I (D7 b C1 F-- , S 44- � 1 Q l7 Jam► , , f l'1 <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 /> � a - <br /> � . 03 <br /> .es _ <br /> � /* . <br /> _ <br /> I recommend: Approval Denial Continuance Inspector's Signatur or ` <br /> �k�'e dcxit***$r*r'r irxic i�ic is 9c is�kxx�r>i is is is�c is�c rc�c�c�t a'cx�c�k�t de�F icx�c r'r*�Ezr'r*ir it 3c icx�E tE of�e*7c is icxic rc it is is is it ic.' t/e 4e �r�kxa'e�e 3r 9r ani 9e dt*ie <br /> b <br /> Supervisor/Lead Senior Comments: <br /> 0 <br /> B_ a 0:)- V <br /> F: �a •oy <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST.* Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1199 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />