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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# . '/9- 99'- 50 <br /> EHD RECEIVED APP.REFERRAL: - '7 - 9 COMPLETE & SUBMIT BY 7- 6 -99 <br /> DATE DATE <br /> ATTN: /'�G, U om n <br /> SITE ADDRESS: 0,3 (4j() Pd : P() n r j /?(J, 0 G .O <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 /> / 4P r« .te t J,-Q h aAdf "!21Z <br /> V di I S) "rude S c e, r <br /> G T r <br /> I recommend: ApprovalDenial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> 131 <br /> -� 123 <br /> Mr,40AAea '0 5 <br /> 404 1ff 47 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> r <br /> I OA 11 CHECK OLIST: Proofread report? Correct L ND USE#? <br />\ EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LA1vD USE BOOK? <br />