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NOTE: PULL ALL PERIVnTS (SEPTIC, WELL, ETC...) SAKE COPIES FOR FILE <br /> LAND USE REPORT ��f� /I(l� APP# ��}�} ,O '�I l oy���s 4� <br /> EHD RECEIVED.APP.REFERRAL:_N/2V/0 J COMPLETE & SUBMIT BYa I?VLA 1 2,M3 <br /> DAT 1'/ TATE <br /> ATTN: <br /> SITE ADDRESS: `J 5 S r <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 /> 1'0 <br /> 3t lrGce✓ �yyi t c + a . � L`c �j iL � %' <br /> H- 06 <br /> / - // to 1% i r ` � UA <br /> o �� a <br /> eq .. <br /> w <br /> �••;OL <br /> I recommend: Approval_�ZDenial Continuance Inspector's Signature j,✓ti�isn � � <br /> Supervisor/Lead SeniorComment§:.• �� ` r�rwty <br /> Us- �O,U, rte.fin: _ <r �•e,�9�1 _ <br /> r • t ter. <br /> 'lt.G'6'77 '?'J Q 11•)�_(.��A Oa.- ..s � ✓ � _ _aC �. ,c.�.U/ <br /> SUPERVISORILEAD SENIOR APPROVAL77- ZPlz�jD <br /> OA H CHECK OFF LIST: _Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rer IM 14 /UCorrect CONDITION(S)? _Logged in LAND USE BOOK? <br />