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,��//\ 6 <br /> NOTE: PULL ALL PERNITI S (SEPTIC, WELL, ETC...) NYAKE COPIES FOR FILE <br /> LAND USE REPORrT� Q APP# �j0 19, <br /> EHD RECEIVED APP.REFERRAL: �1 O .3 COMPLETE & SUBMIT BY ✓/(L%/�� <br /> 6ATV <br /> 11 p / D E <br /> ATTN: Jn r.D /v Ub i GI E S <br /> SITE ADDRESS: 3b5 / /� <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 /> �C 70 . e �Y,,��wc • r� \�W mev� �vr ,� �fl ate? <br /> I recommend: Approval Denial Continuance Inspector's SignatureZ+ -&- <br /> �x,�x�*xx:�xxx*�xxx;x�**K:�xxxxx**xxxx;*�xxxxx*x*Kxx*x*,�*�xxFxs�xxxn, xx, x�xxx�;.x**x**xxxx�*xx <br /> Supervisor/L�ead Senior Comments: <br /> / <br /> L) 7 <br /> !o dao c -a - <br /> A40a6e, 14 .,t CI,. <br /> _4 <br /> SUPERVISOR/LEAD SENIOR APPROVAL ' <br /> V Imo✓ 0,111 CHECK OFF LIST: _Proofread report? _Correct LAND USE#7 <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />