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NOTE: PULL ALL PERNri-TS (SEPTIC, WELL, ETC...) i,-OkKE COPIES FOR FILE <br /> LAND USE REPORT APP# �=2d - q 2 <br /> EHD RECEIVED APP.REFERRAL:_ ,,- -9q COMPLETE & SUBMIT BY 9 — a <br /> DATE DATE <br /> ATTN: l�Q 400A-)a <br /> SITEADDRESS: S-�evcnson AtRooe , <br /> [n 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: //� o io Public sewage: <br /> SUMMARY OR COMMENTS: <br /> GH ;o► I <br /> nn <br /> �eIF&-,(, <br /> UiIl�air�� <br /> I� -. 0 'Z <br /> FOT sere S ✓J�Grk� I6GOLXE� dPl / S�PI/Erfs9N <br /> � � .os 6XIs�i✓Jr �cioL1� 5y5�m lcY .felar' 3(Z'S5lEvans Ma�taUFl�eusPdK ME•J <br /> OFfite 1?,u lel n. .Il+e pttt,+ n6 -t",< MWybe used j, rov.n,4 kF r Zn5/Je�4l» �7 FN -s iJc�of. <br /> "r0 "t C-p re gnu v FN'I E-vl. s GO al- Fe a �-s - > , � - _ __ •r <br /> 7 �' Sb7i U 7 i <br /> /5-lo z <br /> _ e s <br /> y1Te[d o✓ Pa n u5f{�� - sfywd <br /> I recommend: Approval Denial Continuance Inspector's Signature 40L%/Joy-) <br /> Superviso <br /> r/Lead Senior Comments: <br /> �l <br /> - r. <br /> ( .,t 1 A 3( w' SFuA* Mcu&yV Ire vW <br /> -Vo2 c SUS#s de 2c aed <br /> 1501 � a5 -k t IC�?-n7 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 11 CHECK OFF LIST.• _Proofread repos? _ Correct L ND USE#? <br /> EH )s 06 Rev 1 r99 Correct CO;VDITIO.N(S)? _Logged in LAND USE BOOK? <br />