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/ <br /> NOTE: PULL ALL PERN�.'S (SEPTIC, WELL, ETC...) D..,KE COPIES FOR FILE\ <br /> LAND USE REPORT APP# ^� �^^ W J <br /> F.HD RECEIVED APP.REFERRAL: 1 O� COMPLETE & SUBMIT BY I oC / I ( /O d <br /> DATE l DAE� <br /> ATTN: <br /> SITE ADDRESS: � i L �SL S h1C KIACJi e OLk -"`- elr' 'j ' J\4� <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: z Public sewage: irz <br /> SUMMARY OR COMMENTS: <br /> // � ��-,$ c�ctr-� c2.. .ur - � ��'y /�'." .T�i �1r�' -�'ze�•�rr- �i,+ •rnri� <br /> lee <br /> 10 <br /> // � <br /> I recommend: Approv I Denial C optuanceInspector's Si a e <br /> Supervisor/Lead Senior Comments: <br /> � y <br /> /029 C <br /> Qa � ` o �. f�a...cs.•us�•- �t .,Q +� fie...—� <br /> gee,- J <br /> SUPERVISOILEAD SENOR AZPROV�AL: <br /> ,04v�re. ,t�z�y'I"6s.� <br /> OA H CHECKOFF LIST: _Proofread report? _ Correct LAND USE#? <br /> Logged in LAND USE BOOK? <br /> EH 06 Re 1 !, Correct CONDITION(S)? _ <br />