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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: 5 99 COMPLETE & SUBMIT BY -/ 75- % 7 <br /> DATE �- DATE <br /> ATTN: J(� -W 0'r 5//�1--�''�_� p J <br /> SITE ADDRESS: `92516 Pkt) �m , ������✓ <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: ,1,n Public sewage: �1 <br /> SUMMARY OR COMMENTS: <br /> A . oy o a <br /> - SVt 14 C-A:9795 41sV-544- (5. o 7- <br /> 01 <br /> c1 102 0-7 ) oz-. 04 J o Z . o-,�; � ,� v►,1DCSCaP�vnY' <br /> 4. -rd E �QPL7�4 v,� o.= -r�� x rs-n� ��� Grail^4�-r52 =d�,�2c-E c ,4 AC,. P <br /> A k!o�^ <br /> S,A A.0A0-Q S -S _�.� a ui-L E--IAI -70-S I C C4-A'F'B 14-15944- f;r,4A6AAneJ <—A-rF OC w L) <br /> S S C p ` rA AAC /`1 X7'1 TAE 4.A-r <br /> I recommend: Approval Denial Continuance Inspector's Signatur <br /> fe►,L A o .T� s.et=�-T�rl o G��v�vnl r1► �.ArrEe �r517 <br /> Supervisor/Lead Senior Comments: <br /> -7 <br /> SC;PERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST.- L-Proofread report? Correct LAND USE ? <br /> EH 06 06 Rev 1199 -6.L�Correct CONDITION(S)? _t,/ Logged in LAND USE BOON? <br />