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K- C7- <br /> -N <br /> --Nt FE: PULL ALL PERMITS S (SEPTIC, WELL, ETC...) N t�KE COPIES FOR FILE <br /> f <br /> LAND USE REPORT APP# CYC-52 _ <br /> jj DX- 0e <br /> EHD RECEIVED APP.REFERRAL: ?-A-00 COMPLETE & SUBMIT BY rT S /-�p E - a <br /> DATE DATE <br /> ATTN: ��lVt L /ri n (50 re n <br /> SITE ADDRESS: / V V()_V . C * K (L4idj lie101oq <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.... A �- <br /> Public water: �� Public sewage: A ' J <br /> SUMMARY OR COMMENTS: <br /> G t4 <br /> a r1 <br /> 27- ' 03 nq <br /> *Il" Isl`la`� fi Wzf2 �ien� / 011Th "A <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> r � <br /> 1 ' 0 7 -�o .-L�[ .,, <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: _Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />