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NOTE: PULL ALL PERMi,,S (SEPTIC, WELL, ETC...) M,.KE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: ] 3 COMPLETE & SUBMIT BY S 0 -a -Q�D <br /> DATE DATE <br /> ATTN: �r f1�n V�`�� rwy_Jj1 <br /> SITE ADDRESS: 8,1 {Q LA-) <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: _ Nd ham. Public sewage: <br /> SUMMARY OR COMMENTS: <br /> I • ,� s t s• • <br /> I recommend: Approval_ y.Denial Continuance -Inspector's Signature / CG-�-c,�/ <br /> Supervisor/Lead Senior Comments: <br /> 22, 0 <br /> V <br /> o <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> QA 1I CHECK OFF LI"S, <br /> T. 'Corrct LAND tTS #9 <br /> gs ' � i �` Correct CONI?ITION(SJ � ` Logged fn LANF T1SE BO(1K� ` <br /> EH 06 06 Rev 1149 <br /> ,3.7. Y„�i i,�3� ..,,..,ic .-.,.....�€�#.**(��asn?':ma: e7'h � ..;•�x�k,g.bEs a-�.Ms.Srz�.:�..'K;_ .»�,�°.a,.`� -'z,.�`-z s."I'°�=' i,.:.�aH:�'�.�" w*"�-r'., <br />