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Y .. _ • " <br /> YLG <br /> NOTE: PULL ALL PE� (SEPTIC, WELL, ETC...) NCE COPIES FOR FILE <br /> LAND USE REPORT APP# L/A <br /> OL-ao—oj J— <br /> EHD RECEIVED APP.REFERRAL: A-13-01 COMPLETE & SUBMIT B ` <br /> DATE TE AX + I 2-Ak/61 <br /> ATTN: lP,nnl '° TOl/e <br /> SITE ADDRESS: //,F// 9 R'oa S � <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 populatio nsity, location of house, wind direction, etc... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> i <br /> LL <br /> I recommend: Approval Denial Continuance Inspector's Signatur <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> CHEGK OEF�LIST -,"e "Proofread report -4*Correcf SAND USE#9' <br /> Coriect'GONDITI011I{S) .Logged in LAND USE BOOK? � <br /> EH 06 06 Rev 1/99 <br />