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#NOft: PULL ALL PER11 'S (SEPTIC, WELL, ETC...) 1 XE COPIES FOR FILE <br /> LAND USE REPORT APP# SP-0I_ -�;Z <br /> EHD RECEIVED APP.REFERRAL: / b COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: Dann p MU e it Zr <br /> SITE ADDRESS: a23 L d Al �� /�r n L til 360 c4ir/I <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 /> O <br /> l0,'0LI <br /> 20 ',0zi- (b) iyA-T-6gZ <br /> I recommend: Approval Denial Continuance Inspector's Signature ,* <br /> Supervisor/Lead/Senior Comments: <br /> � y <br /> aoos' <br /> 14 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OF-LIST: Proofread report? IL Correct LAND USE#? <br /> Eli 06 06 Rev 1/99 1 iL,/ Correct CONDITION(S)7 Logged in LAND USE BOOK? <br />