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• �G <br /> NOTE: PULL ALL PERNITfS (SEPTIC, WELL, ETC...) M kKE COPIES FOR FILE <br /> LAND USE REPORT APP# Pa-L-) -3 - � tlIJS ) <br /> EHD RECEIVED APP.REFERRAL: O COMPLETE & SUBMIT BY /,?' 0-3 <br /> DAYE <br /> I ��// //�� DATE <br /> ATTN: �)k� ��� ! Y� % /'�_T1ill <br /> SITE ADDRESS: / g 3 S a `<,- f� A Ay <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 /> C� <br /> /% G3 2/ G <br /> I recommend: Approval-- <br /> pproval Denial Continuance Inspector's Signature <br /> *•:�:�***,txxx�����[.:�*�t,�*>k,t�*�***,�*�����x���xr*,��xxa <br /> SupervisorfLead Senior Comments: <br /> d n <br /> O� ;1 2,1- cl /Curt, <br /> -�u cwc�P �� �»:D'+-ot,'�-� cv» oU�,l�►+. �O Y��-.� fit_-��",4�.�w1.� <br /> VV <br /> Q atcc 0 <br /> on aoo3 <br /> � •oS b c <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> .2_P 0f <br /> OA 11 CHECK OFF LIST. Proofread report? Correct LAND FTSE#? <br /> EH 06 06 Rev 1/9� Correct CONDITION(S)? _Logged is LAND USE BOOK? <br />