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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC-) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# l--lq 9 3 <br /> EHD RECEIVED APP.REFERRAL. -qq COMPLETE & SUBMIT BY rb4� _ <br /> DATEDATE <br /> ATTN: T 111 a Gl}�,ff /yl e i J .p r- <br /> SITE ADDRESS: I d,5 00 LE , fla/ke_r IQQad . 4eati, 42 cz -- - - -- -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 <br /> tc.-_- <br /> Public water: Public sewage: '"" ' <br /> SUMMARY OR COMMENTS: <br /> r; . <br /> I recommend: Approval_jz Denial Continuance Inspector's Signature m�c� <br /> Supervisor/Lead Senior Comments: <br /> i <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA,1I CHECK 4FFCI oafre;�d repo , orrect CA1VR USE#� <br /> .n T r., EH 06 06 Rev 1199 ;" Z---Correct�CONDITION(S) '. =i��" ,Lagged in LAND USE BOOl'C�, <br /> y.f <br />