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NOTE: PULL ALL PERNt-FTS (SEPTIC, WELL, ETC...) l-'AKE COPIES FOR FILE <br /> LAND USE REPORT APP# S y- -U / -- <br /> END RECEIVED APP.REFERRAL: 9-2 —Q/ COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: 1-e-6,n rl e- <br /> SITE ADDRESS: I 06 / S ,S f • /c'-/-, q 21 L mal. dj A Ca <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 /> ,v4&14 <br /> Ot <br /> •Qs r. <br /> 6 r <br /> I recommend: Approval Denial Continuance Inspector's <br /> �cxi<ix*xir�cx:E�c*r'c�c is irx*x�cx�r�c�c it*x'fcx*ic>c�c is rcx�r>c is�cxic r'r*ic�cx is�Fxx�F xic irxicx Yc>r�Fxsc�c 4c o�c� �cxx�cx�c ixxic iczxir icxx <br /> Supervisor/Lead Senior Comments: <br /> 0 <br /> A�• i J � o � <br /> j7c .9 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <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 />