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NOTE: PULL ALL PERMi I'S (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# J�15 q 9 - -?q <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY —ly 00 <br /> DATE DATE <br /> ATTN: 65�-Z� <br /> SITE ADDRESS: g q clcl Pe /A e r Rd . A ce-wy-p° <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 /> /Tk Q i <br /> /19 <br /> Z <br /> 6) eeZ 5 a" <br /> 07-1 AG:6 <br /> 6 .� <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �F 9c 9cx*fie is ie�e�'e�e�F�e�F ix 9c�e�c�c�c*fir�c ie�F�F ie rcxic is ieXie is is�F*fie ar�c is ie is*fir 4r ie�'e�'cxde�e*�exie ie it�F*a'c*�Fx9c�e�e*�k�F 9e iex �e re ie�F�e�e�e ie�e�r�'e �r�'t ie <br /> Supervisor/Lead Senior Comments: <br /> 1 <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 LAND USE BOOK? <br />