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d <br /> NOTE: PULL ALL PE S (SEPTIC, WELL, ETC...) r7AKE COPIES FOR FILE <br /> LAND USE REPORT APP# aL <br /> 1 <br /> ` IQ11 <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BYA AP. V' <br /> DAT DATA , <br /> ATTN: v��G�/1 �)— <br /> SITE ADDRESS: asy6p Is. <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 /> f <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> a'r:F�e9cir9r3cvF-Jcicia*nFx�r�r�kk9e�e*�<9c�4**�k**�c**ic*ic**�F-Jc*ic**dc�F�'c*i'e*�c*$c9c*�F**kicie�cic�F�elr$eiv�r�'t�t�t>cir�e*Fe*�c�F******ic*ic** <br /> Supervisor/Lead Senior Comments: <br />;i <br /> I� <br /> I <br /> i <br /> I <br /> i <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> �OAIICHECKOFFLIST � �Prnoreadre ort? �� Correct LAND USE#f� <br /> 1 p <br /> EH 06 06 Rev 1199 Correcd CONDITTON(S)P '``Logged in L,4NDYUSE BOOKS r'" <br /> 7777 <br />