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NOTE: PULL ALL PERMS (SEPTIC, WELL, ETC...) KE COPIES FOR FILE <br /> • 1 <br /> LAND USE REPORT APP# yA S -M— / <br /> EHD RECEIVED APP.REFERRAL: F W COMPLETE & SUBMIT BY CO <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: 1 )09 / pl , � i-A r/c ���1 TLr>(4 r <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 /> 2 -D may- fik ���� ,� �5AJ. 1 y V3 e�) ��✓tee/ <br /> I recommend: Approval V Denial Continuance Inspector's Signature <br /> Hca'c�c'circ'c�c�c9rxix�ciricirFir�c�c�c'c�9r9rsr9e�cx4r*xicx�c�c�'c�cFicicx 'cicxic*k�e9c�c�r�cF**a'c'c* c�cicc��eickie*F9cF*9c*�ck�e9r4e�c�e4eic�cc x4ex <br /> SupeDrv' or/Lead Senior Comments: <br /> 11 l.o <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECKOFF LI T. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev v99orrect CONDITION(S)? ogged in LAND USE BOOK? <br />