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NOTE: PULL ALL PERY**rrS (SEPTIC, WELL, ETC...) 1VirfKE COPIES FOR FILE <br /> LAND USE REPORT APP# �2Z - OD-1 r' 6 <br /> EHD RECEIVED APP.REFERRAL: 10-9-0-2-- COMPLETE & SUBMIT BY 0- / 8 ,.0;)- <br /> DATE <br /> ;)-DATE 1 DATE <br /> (/V <br /> ATTN: NVA,-) ftVt/� <br /> SITE ADDRESS: ti 5 "' l � 1—,1,d-k Y-b <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 /> I recommend: Approval Denial Continuance Inspector's Signature <br /> 9c 9c kx'e*9e�r't�c 9c�r�c ix*9c�c rc 9c Mfr it�r**�*4c is is F sc�c n"ea'eXic 9c�e 9c ie*ic$c�c$c�xit ix is 9c 9c*�c 9c is is*ic isxicxei ai is'c+e 9e 4c Fx9c�e�c't�r do*fir�c �cx�e de��e is <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA If CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EE106 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />