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NOTE: PULL ALL PERa,ATS (SEPTIC, WELL, ETC...). AKE COPIES FOR FILE <br /> LAND USE REPORT APP# Pa -o a -lH8(ms <br /> EHD RECEIVED APP.REFERRAL:y 0 a COMPLETE & SUBMIT BY ,J- 7 -0 a <br /> DATE DATE <br /> ATTN• Irk Cir ; F74i11 <br /> SITE ADDRESS: 'S c,L,:w I RA z m P n <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 /> /4, /U <br /> 2, . <br /> I recommend: Approval Denial Continuance Inspector's Signature . Ak , <br /> ��:����:�������,��*x�*�*x*xxxx*xxx�;�xxx*,�x***�**�:�*******:�***x****:�xx��.�.***�� **x:�::�x• ,�,�**� <br /> Supervisor/Lead Senior Comments: <br /> 6y <br /> L <br /> - G <br /> a -, v <br /> l>< <br /> SUP RVISOR/LEAD SENIOR APPROVAL: <br /> OA I/CHECK OFF LIST: _Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 _Correct CONDITION(S)? Logged in LAND USE BOOK? 11 <br />