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NOTE: PULL ALL PERM*rfS (SEPTIC, WELL, ETC...) N-MKE COPIES FOR FILE <br /> LAND USE REPORT- APP# S 19 -00 -0-5 <br /> EHD RECEIVED APP.REFERRAL: - / COMPLETE & SUBMIT BY -7 -Oa <br /> DATE DATE <br /> ATTN: Gl. r J c7ry' -ell.- <br /> SITE ADDRESS: J 15 Q !5 E- , 5 1 . 2"f � l2 O A n -fit Cr, <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: /V'/ Public sewage: AM <br /> SUMMARY OR COMMENTS: <br /> eie�"dyi Ar /4j4A eld z� <br /> q <br /> _ C (JICF- <br /> C ,lee <br /> 15, 1 . v <br /> I recommend: Approval / Denial Continuance Inspector's Signature 2 <br /> Supervisor/Lead Senior Comments: <br /> 6q,.-- <br /> 3 vor- <br /> - <br /> .. �_ ., <br /> 7 8 S <br /> ' — <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> � lyy:o � <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 E . Correct CONDITION(S)? Logged in LAND USE BOOK? fl <br />