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NOTE:' PULL ALL PERK 7S (SEPTIC, WELL, ETC...) PEKE COPIES FOR FILE <br /> LAND USE REPORT APP# W -0 3 <br /> EHD RECEIVED APP.REFERRAL: .. ( O—&3COMPLETE & SUBMIT BY (�Y',(J <br /> DAT II'' L, 0� DATE <br /> ATTN: i C,1L n �,� n -r■ <br /> SITE ADDRESS: ��.3 ys (Dr-/An <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 /> 17 <br /> t - , <br /> I recommend: Approval Denial Continuance Inspector's Sig <br /> *x�xx*x*x***:�xx�xx�**��:�*xx*��xx,�xxx�xKxxxx;K;nxxxx�xx*x**xxxKxxxxxxxx*,��� ��,�xxxx�*,�+x*x <br /> Supervisor/Lead Senior Comments: <br /> �n2wl <br /> 42 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: '`'w. <br /> OA II CHECK OFF LIST: _Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />