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LT <br /> NOTE: PULL ALL PE1rNIITS (SEPTIC, WELL, ETC... MAKE COPIES FOR FILE <br /> LAND USE REPORT APPS _SA-`Y-i, A <br /> EHD RECEIVED APP.REFERRAL: 6-9-q9 COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: Je-F-F lr- rha.r <br /> SITE ADDRESS: 3q75 Al 6 ), lr,)n tUA z AS 39 d- d� y k-11 d( . <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: A 14r- Public sewage: T�— <br /> SUMMARY OR COMMENTS: <br /> O(o <br /> I recommend: Approval Denial Continuance Inspector's Signature" <br /> <*r.��:,:«.+.�:,.�*,.,.t.,:;.��*,:,r,:;.:x,:,:***;.,:,::x•,.;.,.�**:exx�x,�*,�xx;.�.;.��+:**,:**�x,��:*,:x:x�***�,.:x*xxx <br /> Supervisor/Lead Senior Comments: <br /> ,On a� nes <br /> SLPERVISOR/LEAD SENIOR APPROVAL: <br /> O.t/I CHECK OFF T.- ` Proofread report Caned LAND USE*?' <br /> EH,R,06 Rev i,w Correct COND(TION(S)? Logged in LiND USE BOOK? <br />