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zw <br /> NOTE: PULL ALL PER1V,,.S (SEPTIC, WELL, ETC...) T EKE COPIES FOR FILE <br /> LAND USE REPORT APP# / I�I7 '7/S <br /> EHD RECEIVED APP.REFERRAL:_ COMPLETE & SUBMIT BY 10 / / /�r <br /> J� lI Da <br /> ATTN:a <br /> SITE ADDRESS: In� �Y� ins S �L � ( �� n)o <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: X-2-- Public sewage: <br /> SUMMARY OR COMMENTS: <br /> �/"�� ��J�ii/� � r irr/ � -y. i^i �—�, �:- i�f r 1, �� fr=..tz�..c�✓ <br /> r fn i <br /> -"!tE <br /> �- <br /> ' <br /> I recommend: Approval Denial Continuance Inspector's Signat e <br /> Supervisor/Lead Senior Comments: <br /> C <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CIfECK OFF LIST., Proofread report? Correct LAND USE#? <br /> Ell 06 06 acv 1/99 Correct CONDITION(S)? Logged is LAND USE BOOK? <br />