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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...)MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# .s�7- 9/g ,5y <br /> EHD RECEIVED APP.REFERRAL: 6 �d! % COMPLETE & SUBMIT BY / <br /> DATE / DATE <br /> ATTN: Nana g A r 1nejsler <br /> srrE ADDRESS: <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: I �14 <br /> SUMMARY OR COMMENTS: <br /> Cl' /94YAVAL. PrtiO2 Ca T'dE A44 7r l To -r4,e [. Sn14C54sas -r4l. <br /> AVw.a W-of g.00.as -r7lA .I A GLosE't"C' e" Pees/FrOHlLYQoOMS ew Ta6 a", o <br /> -r?JW4-eE / -rAGA-r-A6 SgFra'riG s rsT e,47 Sfl,4 c-,M 1064440 /� Acc 20/ 4 Ta -rA c s S Go <br /> ,eA6-gA,3 s6"ca c !Tr-A !2 �AY1QrPA1/4 rAPr7/T1ia. . cpe vA6A4o,=-ra -rrlssEP-r/� srs <br /> .3RW K FiF VAOBC fYiS'E/� PER+�1/T ANt1 TSS P F GTi o <br /> Ci <br /> "All rvV�^TrO�� S��T .P.rfs Lf AQ1 it GNO y5 Sryy LL 13 X•EaAT S'�/�.Q �'7 TrOE Sc�'r/L. <br /> r TAAK AA6 ry F.a±7 -rrle c4Aca14 n``��5 GE—=f4iGA5 /I1 T5 1 <br /> C) -e4"fArA/n\ A O ZTA n�C.41' 0, 7 S 0r�,«4�Ayt-r- Fo n�,�4 T/ot�d oP <br /> o✓F.�°rl/4olGr T� -rte Ham..:-LL <br /> [ recommend: Approval ( Denial Continuance Inspector's Signatu <br /> Supervisor/Lead Senior Comments: <br /> n l as 5 d)r" ��y , <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA If CHECK OFFLIST.• Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rev 1/99 �orrecYs _ CONDITION(S)? ZLogged in" D USE BOOK? <br />