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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) IMAKE COPIES FOR FILE <br /> LAND USE REPORT APP# ,5 - <br /> EHD RECEIVED APP.REFERRAL: —7-7 — COMPLETE & SUBMIT BY—? — lam'— F2 <br /> DATE �- DATE <br /> ATTN: `jo 4-7cF�/V r' <br /> SITE ADDRESS: 53,90 IV , 7-12fiv jCd. . J--//j G/eel <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: �fa=_ Public sewage: 14- <br /> SUMMARY OR COMMENTS: <br /> ` <br /> C71 = TKay : .S,�I Z-t-kz5l IV cy- '7/WZ /� L•G Ld�► L1�r�'S'��yi'� [1 T ��T'GC� vLIL L <br /> 4 LoA6 "7�IIi �yL��/`, / G%1� r/Lem' 1-11—i VI C" T . <br /> ,,16%e c.%,p L-vin eA&6 -C JC_' /,-yG4 rEyJ pA -r-d JF c v L,& 6 0 <br /> A<t�N Cr <br /> -7-49 1177d vt=- 'T/JC /dao ue9, ,�/8 -r'_01 A� 'r <br /> / Fay.-'-'AA vIar r7 <br /> A -Ts►.�,5 4&e,-,64 IV_A .6166.7/ L� i�JC��t i i,moi �li � <br /> I recommend: Approval_ Denial Continuance Inspector's Signatur <br /> Supervisor/Lead Senior Comments: <br /> �- <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA !I CHECK OFF <br /> IST: __L roofread report? L Correct LAND USET <br /> EH 06 06 Rev 1/99 orrect CONDITION(S)? -ed in LAND USE BOOK? <br />