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NOTE: PULL ALL PEARTS (SEPTIC, WELL, ETC...) ,..AKE COPIES FOR FILE <br /> LAND USE REPORT APP# l5 <br /> EHD RECEIVED APP.REFERRAL: S -3o-qq COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: n C� �� r (� i _ r <br /> SITE ADDRESS: r700(0 r , l/v e-S� _&R m k i-) � W i' t n �c a <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: IV <br /> SUMMARY OR COMMENTS: <br /> _ 03 <br /> I recommend: Approval Denial Continuance Inspector's Signature s <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> Ort II CHECK OFF LIST. Proofread report? Correct L4:v'D USE#? <br /> If 0606 K,:v 1,99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />