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lee <br /> NOTE: PULL ALL PERI.TS (SEPTIC, WELL, ETC...) KE COPIES'FOR FILE <br /> LAND USE REPORT APP# Pk -6 Q _-a�1q <br /> EHD RECEIVED APP.REFERRAL: j OZ- COMPLETE & SUBMIT BYA, A P JRY 6!-7/�—, <br /> DA E - --_ <br /> I `DATE <br /> ATTN: <br /> SITE ADDRESS: 3 Y� ___--- <br /> ln 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: /20 Public sewage: <br /> SUMMARY OR COMMENTS: <br /> aa. o <br /> I recommend: Approval Denial Continuance Inspector'sSigna Ire <br /> �cic3c�k�cic$ckic�cicic�:c9cx*ic�c�c9c�c3s:E$cic:E�cirdckndc�cdc�'cvtk$c9r9rxxx$rxiex�rfrx�c�ex�4xt's�Eis�'c�rxFcx9edca'e�'cdekde�Fir�e aFicxok�riricir do dcvE:�vc�c <br /> Supervisor/Lead Senior Comments: <br /> of IAA& -A <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> EH 06 06 Rev 1/99 g 4 orieJ ENTERED IN LAND USE LOG ✓ ppg�F <br /> �. _ <br />