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N <br /> ' NOTE: PULL ALL PERMS SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LANI_� USE REPORT APP# S 19 "�'0 -51 <br /> EHD RECEIVED APP.REFERRAL: f tTj COMPLETE & SUBMIT BY / l/ -3 -0 0 <br /> DATE DATE <br /> ATTN: 1 .1 G, w� -h toe , <br /> SITE ADDRESS: O o G4 /1C d O C,ke A-)L a/ <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 /> /220$ e — �RuVi �E SAMPt,E ZA-P 2to2 S ANG �t�EtK <br /> v VA-�vE �4L.Sb ��vl�. Sc.fZC-EN Fc� W�t-�- t-4-�AJ VLNr, <br /> 1✓'� I Oho � . ,:�_ <br /> 1501 <br /> r 6 <br /> - i 1 <br /> I recommend: Approval Denial Continuance Inspector's Signatur ' <br /> �t�c�cxdeic9ca'c�cir9c�'c�c9eic�c�c�e*�c�cdc�cxicivie�43c9cic9c3cic�cir�cirxic�E�c*�e*i'c9e�4�e��cicic�'c�c�cic*�cicicxic�cieicie�e�c�e�c�c�c �c9e r e9c�c3eic�'e�c3e9c ricicx <br /> Supervisor/Lead Senior Comments: <br /> oaZL <br /> 'l <br /> vv <br /> I S'o l <br /> SUPERVISOR/LEAD SE'�IOR 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 />