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e61ME <br /> -13-OTE: PULL ALL PEFj..�TS (SEPTIC, WELL, ETC...) AKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: OL COMPLETE & SUBMIT BY 0 �. <br /> DATE // —T <br /> ATTN: �y GIS (. rl�jll DA <br /> SITE ADDRESS: y 10 S � n l J:tzti P\,o L(1 S c K�Lea <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 /> 7e cl� Vicf > e �>c oat we�l N <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> *xxxxxxxx*x�*:�x**xxK*xx*n*; xxxx,�x*xxxxxx�KK*xx*x�xxx�****�xxK �K,�xxxxxx**rxxxKxxxxxxxxxxKxx <br /> Supervisor/Lead Senior Comments: <br /> d <br /> 0.: <br /> TC Q <br /> S 3 <br /> 7 <br /> -;� <br /> SUPERVISO EAD SENIOR APPROVAL: <br /> F[OA7,11CHECK OFF LIST: _Proofread report? _Correct LAND USE#? <br /> FH 06 06 Rev veq Correct CONDITION(S)? Logged in LAND USE BOOK? <br />