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NOTE: PULL ALL PERIVI'6'�'S (SEPTIC, WELL, ETC...) YnKE COPIES FOR FILE <br /> LAND USE REPORT APP# L[ y 1 <br /> EHD RECEIVED APP.REFERRAL: 1 -1g-00 <br /> 1g-0i] COMPLETE & SUBMIT BY a 7-00 <br /> DATE DATE <br /> ATTN: J �►r► Jan 8U re rl <br /> SITE ADDRESS: L5? ,5r412all- 2 t(, Lz. d 1' <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 h e, wind direction, etc.... , <br /> Public water: 1 � Public sewage:. �i- ai A ' •+ <br /> SUMMARY OR COMMENTS: <br /> CIO r 6 <br /> � 0 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> C\/ <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA Il CHECK OF GLS'T '_ Proofread report? Coirert MND USE#� <br /> EH 06 06 Rev 1199 Cnrree!C01Y] ITION(S)? Logaa ged tx LAND V EBpOK� <br /> �°+a,' <br /> i <br />