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NOTE: PULL ALL PEW' 'rS (SEPTIC, WELL, ETC...) P KE COPIES FOR FILV��_; <br /> c <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: �, - - ! COMPLETE & SUBMIT BY �� y <br /> DATE DATE <br /> ATTN: h r -)r LEL /-I <br /> SITE ADDRESS: (L:(�, r/ , S f o k�s T�yt U 5 J_>'C r� <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 /> /-z C'GctCa c4—1 .✓ iYL7 -�rI <br /> f����� 7�L`-�°!-lril zc�/.5 ia�/��✓.�c%�c-�-zc3 /fin/�r�7i%�6 �ZG <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> JCXX}CXXXXX)C)CXXXK�GX)CX%�C)CX)CXXXX]CXXXXXXX:CX:C)CXXXSCX)C)CXXX)C�CXX)CXJC]C]CXXX%X�C)CX XXXXXXXX>C:LXXX XXJCXYXX::X;C <br /> Supervisor/Lead Senior Comments: <br /> oy <br /> l = o S G <br /> SUPERVISOWLEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />