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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...TMAKE COPIES FOR FILE <br /> LAND USE REPORT L APP# <br /> EHD RECEIVED APP.REFERRAL: � A <br /> - -0l COMPLETE & SUBMIT BY C —d <br /> DATE DATE <br /> ATTN: r'S �\e--,- <br /> SITE ADDRESS: i Q 51, t�A '-i 4y-ola <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: 1` <br /> / <br /> 71d 7C. <br /> L �� • a3 <br /> / D <br /> ' a <br /> as:0 <br /> IS, o[[ <br /> I recommend:FApproval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> A . r <br /> 'tNL.CY <br /> r <br /> SUPERVISOWLEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rey 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />