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ms-91-105J� <br /> NOTE: PULL ALL PERM S (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# �1 r- � - � 5 <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY J — —o y <br /> DATE DATE <br /> ATTN: btkk rtn ; ;�-r <br /> SITE ADDRESS: <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 /> 0 <br /> J6 P-ri e— <br /> / - O <1 S K S�'A13 r 1,17-y <br /> 1t v2_ t730I-V r' Ak-re'ZST1rt/G- <br /> i <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �e9e�'e�k�r�c�edc9rx�c�cir�'c�c�e9c�c�c�F9c�c9c9c�c�ca'c*x*�ex�k*�c�Fa'c dc�c�cica'ciei�x�c�eieicicic�c�c*�cx�E�'c�c�cdcic�cie�'c�c�F�c�Y3c�'c*9e�e*i'e�"t�'c�cic�'c�'ca'c�E�'cok�'cde�e�'c <br /> Supervisor/Lead Senior Comments: <br /> -e-A- <br /> U <br /> go <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 />