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'NOTE: PULL ALL PERNTiTS (SEPTIC, WELL, ETC...) HAKE COPIES FOR FILE <br /> LAND USE REPORT APP# 9,4-61 -tea <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY 5 -,9- S —d <br /> DATE DATE <br /> ATTN: .kl�r to Lr <br /> SITE ADDRESS: 4 oQ 6 S 1e-Sat,t,-C-1/L r enm ja 'e— CL (' e"yw <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.... c l <br /> Public water: Public sewage: t t L <br /> SUMMARY OR COMMENTS: <br /> ✓�1 11 ' 7 <br /> 9 � lk : O `� <br /> , p <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead�Senior Comments: <br /> o1 - <br /> — J a] 4 <br /> B �o :05 ;& zo - 6 <br /> C a;� 0 3 o1Q.f <br /> D a-e)J i�+. -� -��«c� amt <br /> E 11 ' 4 3 � " «�- o•(a,�,- Y•�a- ,c..•�.k��� <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA/I CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged In LAND USE BOOK? <br />