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-/V <br /> TNOTE: PULL ALL PER71' 'QTS (SEPTIC, WELL, ETC...I --IIAKE COPIES FOR FILE <br /> SAND USE REPORT APP# L/- -U o <br /> EHD RECEIVED APP.REFERRAL: oG o�r—O COMPLETE & SUBMIT BY /`�'S Y� P oZ -12 D - 01 <br /> s DATE DATE <br /> ii <br /> ATTIC -`�-� '� ue f C �, <br /> SITE ADDRESS: <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 /> shoving population density, location of house, wind direction, etc.... <br /> Public water: Public sewage: Clic <br /> q 1r <br /> SUMMARY OR COMMENTS: <br /> 4j k - !J-xoa <br /> V-I� <br /> zo <br /> !H 1 l.. <br /> i9 <br /> (� f <br /> � <br /> t <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> *********ic****9r$c*:EvE'***aE�e:fr4e*�E�k3c*i�9cie�riraF*o1r�e�c�c�c�rSt9t$t9r3e4e3e�k�e�r�r�k�e�rek�e*�e3e9e�e�e9e*x�'e�evE*3sa'r ie ie 3c ie 4eiaxirieici�ir it <br /> Su erviso�r/�.,e�d Senior Comments: <br /> 'We �o <br /> ' NPS ! � <br /> �- /� , . � <br /> JA�1422VA,- 4114 re -T—J111i, 3 <br /> Y/ <br /> j <br /> 47,SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LAST Ptaafread report? Correct L,4 D CISE# <br /> in BOOK <br /> EH 06 ob Rev lu99 �' Coirecl CONDITIDN(SJP Logged LANDgUSE <br />