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SV I- r-VCP,/ ,�'cf6Svr a�c.-Q- W c p <br /> NOTE: PULL ALL PERI TS SEPTIC, WELL, ETC...)LAK COPIES FOR FILE <br /> LAND USE REPORT. APP# W 5 7-6�O_1 f <br /> EHD RECEIVED APP.REFERRAL: l� ~ 00 COMPLETE & SUBMIT BY � 0 Q _ <br /> DATE DAT T <br /> ATTN: A,g1 rTW�/n <br /> SITE ADDRESS: _5 <br /> Jn 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: ry 5 �,.J��� z *-ea_ Public sewage: �— <br /> SUMMARY OR COMMENTS: <br /> r <br /> 1 <br /> i d <br /> F4 <br /> r <br /> I recommend: Approval Voor Denial Continuance Inspector's Signatur <br /> ****�rFdr9c'leF4*�e�c�r*Jc*deer*$r**4r************'e9e*deJr*it**irivicvk9c�t�'a'Je**1c*Fdciriex�ric********* *******is**9t�e9e 9c ale <br /> Supervisor/Lead Senior Comments: <br /> 0 <br /> C_ P � 0 �- - <br /> y <br /> � 03 a <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> 6,411 CIfECIK 6FFLIST: •. �Proo read re ort? Correct LAND USE#, <br /> k x " � Correct Lo <br /> CON,DITIQN(S) Py gged rn LAND[ISE EO <br /> OK? . <br /> EH 4606 Rev 1199 §Ka �:. ,. <br /> sed_ -5 ,a,.a. ...,x <br />