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< PVk <br /> rr`TE: 'PUL.L ALL PERMS (SEPTIC, WELL, ETC...) 1• KE COPIES FOR FILE <br /> r� nn <br /> LAND USE REPORT APP# 1'4 <br /> J� I "- RAY ON VACATION <br /> EHD RECEIVED APP.REFERRAL: y� COMPLETE & SUBMIT BY �IQlo 7/1/02—7/5/02 <br /> DATE DATE <br /> ATTN: 'L ¢r k- <br /> �- <br /> SITE ADDRESS: ( O 5 DD <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: 120 Public sewage: <br /> SUMMARY OR COMMENTS: <br /> C <br /> I recommend: Approval Denial Continuance Inspector's Sig r —� <br /> xxxxxxx*xxx,�xx+xxxxxxxKxKxxxxxxxxx, x�K�xxxxxx**x*x*xxx�xx*x�xx*nxxKxxx*x��x�K+*xx x*xxxxxK <br /> Supervisorr//Lead Senior Comments: <br /> V <br /> i Zoo �gqg& c w�. ,>'�r► r.Lu�e e <br /> ��'" VV <br /> 'D 2o ' aS <br /> SUPERVISOR/LEAD SENIOR APPROVAL: _: <br /> OA H CHECK OFF LIST: Proofread report? Correct LARD USE#? <br /> EH 06 06 Rev 1199 _Correct CONDITMV(S)? Logged in LAND USE BOOK? <br />