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K%(c <br /> NOTE: PULL ALL PERK -S (SEPTIC, WELL, ETC...) P KE COPIES FOR FILE <br /> LAND USE REPORT APP# Pj- D d <br /> � <br /> EHD RECEIVED APP.REFERRAL: / // Ute' COMPLETE & SUBMIT BY <br /> DAYE <br /> q ATE <br /> ATTN: 1:0 /1 n P i�7dh <br /> SITE ADDRESS: i�x .i c,,4 L—,✓l <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 /> - I. !'y_.,.-,+i�' :1�: r./�.%p: -.:�Xf e00C-�'7EG /�� r7�J'X�/d'G-r+�ta! S✓�L� c'a"..,.C'.'+C'�- i'E'.!/i rsi[L <br /> &a- .e e ?a+` <br /> \1 --a- <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> *:�:xxxx*KxKxK�K�;xx*��**xxn�**xxx*xxxx*x*xxx�xnxxxx**x:�*:�x��:�xxxxxxxKKxxKKxxxKxxxxxxxx*x*x <br /> Supervisor/Lead Senior Comments: <br /> ay <br /> o/ <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1N9 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />