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JJ <br /> NOTE: PULL ALL PER" `S (SEPTIC, WELL, ETC...) w.KE COPIES FOR FILE <br /> r <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: o� COMPLETE & SUBMIT BY 10 — 1c)--j1 <br /> DATE DATE <br /> ATTN: Jenn1-rer 10/&V <br /> SITE ADDRESS: 21a N� GOIden Ca 41 AVenu.0 S424—moi? <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 /> 1411 <br /> � 15: oZ <br /> /02 ;0CA <br /> I recommend: Approval Denial Continuance Inspector's Signature •:,,t-11V/ <br /> Supervisor/Lead Senior Comments: <br /> Q <br /> /o - ay <br /> B �o •ar <br /> c /oz - oY <br /> D �s- o�- <br /> SUPERVISORIL.EAD SENIOR APPROVAL: <br /> OA lI CHECK�FLIST 1Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1199 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />