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T� <br /> NOTE: PULL ALL PER1M r'FS (SEPTIC, WELL, ETC...) AAKE COPIES FOR FILE <br /> LAND USE REPORT APP# / )q - UO - /-2 <br /> EHD RECEIVED APP.REFERRAL: q j i-00 COMPLETE & SUBMIT BY -16-00 <br /> DATE DATE <br /> ATTN: J i M VIA ,i r5o ie n <br /> SITE ADDRESS: �25 75 dE_S �- e f . Ll 4". e S 6ocF �n <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, to ion of house, wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> ""7-o a <br /> I recommend: Approval Denial Continuance Inspector's Signature-f--q !Vd!:! ►sem <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 1I CHECX OFF LIST: =Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1199Correll CONDITION(S)? Logged in LAND USE BOOK? <br />