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S <br /> NOTE: PULL ALL PERNMS (SEPTIC, WELL, ETC...) NrAKE COPIES FOR FILE <br /> LAND USE REPORT< APP# P J�/_O 1' �Jp51 <br /> EHD RECEIVED APP.REFERRAL: ✓ COMPLETE & SUBMIT BY (p/ I i1 1/�.3 <br /> DATE ��D E <br /> ATTN• E , r-L (-)C-1, &6n <br /> SITE ADDRESS: Q7'21 S A�?-Q���� <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 /> —p / <br /> Tr'S7/S <br /> /IleaY ig <br /> Ji' o Co <br /> Zz :OZ <br /> 2z .o/ <br /> // / <br /> I recommend: Approval—V—/ Denial Continuance Inspector's Signatu 7 <br /> Supervisor/Lead Senior Comments: <br /> 'WGA �6 arf20 u <br /> ( d ✓ r l/ <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 11 CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />