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NOTE: -PULL ALL PER TS (SEPTIC, WELL, ETC...; AKE COPIES FOR FILE <br /> LAND USE REPO RT _�� APP-99 <br /> /If�5 <br /> 7 - <br /> EHD RECEIVED APP.REFERRAL: 1 . 1 COMPLETE & SUBMIT BY <br /> 3 DATE DATE <br /> ,,ATTN: <br /> SITE ADDRESS: 'k9 .�—O -,O oy, /e d, <br /> In completing the Land Use investigation, draw all Public Health factors on the e, ibit (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 /> ) SUS <br /> l� <br /> ifi <br /> nV 1AJ e <br /> greco � �� 4 1 <br /> TT j men pproval ✓Denial Continu�ncet�� Inspeor s S[gnature� <br /> xic is icx is c icx�c is ie�c Fx�c�c F�r 9c*�c'c kie hex*ic at is is�c is is it ie ie'c�c�c:F�e F ie*�c*:E�c is�c is is at ar it is is*icx�c 9e is*fie�c�e aF is�e etc de ie ie*ie is*'c rc*_J <br /> Supervisor/Lead Senior Comments: <br /> 4t 6mpL�F'w 0/'ad <br /> 3UPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 11 CHECK OFF LIST. L/ Proofread report? L--Correct L41VD USE#? <br /> 16 06 R w 1/99 v Correct CONDITION(S)? &----Logged in LAND USE BOOK? <br />