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NbTE: PULL ALL PER11�,,.,�S (SEPTIC, WELL, ETC...) I KE COPIES FOR FILE <br /> I w <br /> LAND USE REPORT APP# -5 77 6P)c'10#Oa-5-7wz� <br /> EHD RECEIVED APP.REFERRAL: -0'), COMPLETE & SUBMIT BY <br /> DATE ,n� } DATE _.— <br /> ATTN: <br /> SITE ADDRESS: 94? ,-) <br /> , <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 /> i, 060d <br />!° 3. a-o , <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �e�c dr*xdr�r�Jr 3r'e k ek�e$ek'e n4 eF k 9e$e'ckx*kde�e kaF$e is eY ie x�r iF kx$cx3e dr*vie ak�rxx�r�r k'rkxa'r 9e�r ak$ekx&x�r 9e�exY�e'rx�e lc eF�e kir$e kex�exeFxJr k$r <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECKOFF;aST `"-%N �Proafr ad re�ort0 y `Correct LAND USE <br /> Ex o6 06 Rev 1199 �� Correct CONDITION(.S) j Logged in,LAND FTSE BOOK? <br /> 3> <br />