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NOTE: PULL ALL Pr�r2MITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> 2 <br /> LAND USE REPORT APP# &, - CXR -IV <br /> EHD RECEIVED APP.REFERRAL: (4 - /3 -03 COMPLETE & SUBMIT BY - 3 -OD <br /> DATE ��I p DATE <br /> ATTN: Uvvyl j I ' AG"f �i A <br /> SITE ADDRESS: a S5 pj , I'Cd > <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,, w�n�d direction, etc.... <br /> 4 N1 Public water: it/o�v�' Public sewage.N� <br /> SUMMARY OR COMMENTS: <br /> 68 . d <br /> / Aycd <br /> l <br /> 7i ,'6Gj d t5 dl- / <br /> /l <br /> 4A <br /> I recommend: Approval Denial Continuance Inspector's Signa <br /> Supervisor/Lead Senior Comments: <br /> Q <br /> V— <br /> C- a ;ay <br /> �X11 <br /> n Il: o � <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LANDUSE BOOK? " <br />