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NOTE: PULL ALL PERK 'S (SEPTIC, WELL, ETC...) r` A KE COPIES FOR FILE <br /> LAND USE REPORT APP#�S/4-0/-/ <br /> EHD RECEIVED APP.REFERRAL: c� 16--0/ COMPLETE & SUBMIT BY <br /> DATE 6 DATE <br /> ATTN: �,lot- M uejl r <br /> SITE ADDRESS: 9 6) ,?2AL 4-Vrn—AD►1 <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' PaAtIJ <br /> UZ <br /> pOTE /yo y t_#R 01�C 6A AT au peo Pos& A R uE 4.xa y , r— <br /> AfPRvPRU¢Tt. 4}kT"OklT1E5 SHDUMO $E Por/F/C-6 <br /> lU cc tz f s T7(' `-fou/C' AJ,*r r s5 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> :k*icic*icvFx�E�cx�cixicir�k4c�c�c�Y�r�c�eic�c�ca'e9c*9c 9cic�Ya'cicic�cnk�cicicic�cxic�c�ic�cicic*��c�cie�cir�c*�F�cic9e**�eiciric�c�cir9e�e�c9c*�c�e�fc�'c' xt'cicxirx <br /> Supervisor/Lead Senior Comments: <br /> V <br /> R I07 <br /> 7 2� I <br /> T� T n <br /> 9. <br /> ♦ U f �/IV <br /> j3, 1/ .a.,)- <br /> �l20 •Q S <br /> Fis• of <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. Proofread report? t.'-Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />