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f � <br /> 1 '1 <br /> NOTE: PULL ALL PERM. S (SEPTIC, WELL, ETC...) N1!KE COPIES FOR FILE <br /> LAND USE REPORT APP# C) 1,4 <br /> HHD RECEIVED APP.REFERRAL: ;2 '7 0 3 COMPLETE & SUBMIT BY - /j 0-3 <br /> DAT I II DATE <br /> ATTN: �-- cal r1 E ���Lf--L 1 C_r <br /> SITE ADDRESS: •.y <br /> In completing the Land Use investigation, draw all Public Health factor 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 /> JZ4�Z, i&- ss (z11,1,1_3 . <br /> ✓� ' /G-SC�sZ��7 (S�Zc�s��.� r �i�i�sz�2) <br /> ' �/I���✓LG�1�i4 �'c�� ��"Zc.�='rcd��'f�C5 5�4Zcr�✓ <br /> ' /O 5�-G�-f'L.�LG�'JS c'1��9i'���•c� �Sc�c.���L�"�.?�rr�r./�JC�Z��,�i�i�,(� <br /> Lam` p, f+1wMr+ � a✓ ^fn,�,ti. *R��1 t ..J ' 'wry = <' rl F9wG�*Cy/7,q We -444-2 Y�rs3 <br /> VV <br /> 4Z�!/Lfr.�T/�CLG��`� � �/s7�''�letl7G�''� �0•�'yt//���li%� <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �cxic�c*ic is is 9c is�c�c is is is is�c�c�c�c is�c�e a'ca'c�'c 9exx*x�ex�c�e is a'c is�F ie is it�e�k is 9r ie is icxx�'c ie�'e�eXie�c 9c irxic ie is is is�c�e�c 9c 9c icxic ie ie�F 9e 9exxx�e�e�e�e `� <br /> Supervisor/Lead Senior Comments: <br /> n Y <br /> k VV <br /> 04, ' <br /> VV <br /> /L <br /> ,.y �� • <br /> SUPERVISOR/LEAD SENIOR APPROVAL: ` . <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />