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�r <br /> NOTE: PULL ALL PERAMI TS (SEPTIC, WELL, ETC...) *1I KE COPIES FOR FILE <br /> LAND USE REPORT APP# P A `O�- <br /> EIID RECEIVED APP.REFERRAL: I IV <br /> E COMPLETE & SUBMIT BY <br /> D T ATE <br /> ATTN: <br /> SITE ADDRESS: 1'I a3 6 5 <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 /> -0 u�n 4r <br /> 2,-7,- 03 <br /> 0 6 A I„ <br /> b vi - 0`l <br /> 4)101.- OT <br /> cf� ! � /a S-� .+.�� �(,,.,r� rser�f e�h .,�.�ev.�✓r.rGl/—_,,.csanK ,I ��L` <br /> a � <br /> I recommend: Approval ✓ Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> 2x o b <br /> a <br /> 7 'o <br /> $ //- /0 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECKOFF LIST: __Proofread report? _Correct LAND USE#? <br /> Correct CONDIT/ON(S)? _Logged in LAND USE BOOK? <br /> EH 06 06 Rev V99 <br />