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NOTE: PULL ALL PERNh--t'S (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# U 0V <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY. <br /> DATE �/ DATE <br /> ATTN: � �lU/t r taarl-il? _ <br /> SITE ADDRESS: 17 JZ2 n /U 7-ra <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 /> MORE Ef D E D - Pok D L'oN 2ue7-1o,,u QF s r G 2, - es Fri r <br /> /f' — 1,/AJeD a Gxa�I�1lC-� <br /> 4Aj ,N-f-L> 7f'R Q4.4J.rr-Y <br /> 2. f'aSSta4<- O(A ,TK4, ._.sy��� <br /> r <br /> r <br /> I <br /> E' <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Co ments: <br /> w <br /> X5 C- <br /> J/ `� e <br /> - r w a <br /> .vu - axo ,,�. <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> b <br /> OA II CHECK OF,F LIST ` E, r Proofreari report? Correct LAND USE#9 <br /> EH 06 06 Rev 1/99 ¢ a 3 Correct CONDITION{SJ? ' } ' Lagged xn LAND tISE BOOK�,3i g <br /> u;�.;�.. .:�.`mrsa-,:, tee.:;.�. �xi��.,. gt r� %§�.;;2:??MitPa1` -z3�.'?tnc`.,i.`xin...e? <br />