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L� <br /> 'NOTE: PULL ALL PERM. S (SEPTIC, WELL, ETC...) N.,� COPIES FOR F11LE <br /> LAND USE REPORT APP#f? -D <br /> EHD RECEIVED APP.REFERRAL: a COMPLETE & SUBMIT BY <br /> DATE ! DATE <br /> ATTN: �S2 tZJ L i o A e C <br /> SITE ADDRESS: U g q o l— /I)/) ( h in. /B rt S C�-iO C�167ZO✓2 <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: 7ip-2 Public sewage: <br /> SUMMARY OR COMMENTS: <br /> F. <br /> I(rlecx90 <br /> li** **/*" L**/ <br /> remmend: Approval Denial Contin�u*/a*nY*cex7 I�*nY�s+_*p1*�ecDxtoxr�x'.*2s�imaS�xtir*gixxr x e <br /> xG.*✓�*l*+(.* <br /> Supervisor/Lead <br /> (/ Senior Comments: <br /> ' Q 7 <br /> �a <br /> �'k.rlQG fJ .rtCi'C.— J C "� ,•o. <br /> : o <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA//CHECK OFFL/ST: _Proofread report? Correct LAND USE#? <br /> Eli 06 06 Rev 1/99 Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />