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Kv <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP#J/R- 92-2Ad-- 5?-9 5.3 <br /> EHD RECEIVED APP.REFERRAL: - COMPLETE & SUBMIT BY -3 D- �4 <br /> DATE DATE <br /> ATTN: p jc=c �pAP r � <br /> SITE ADDRESS: i $ 17l � !jjP Z1 0 24LA'dde <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.... y� <br /> Public water: 04 Public sewage: AJ <br /> SUMMARY OR COMMENTS: �A710G WeS � <br /> i �� ,JE <br /> u <br /> r:)6,a c u <br /> lel` jh.P NLu.r✓i PA n "I YO A) L 1/1 14-CAk 5thjl ht wWX �R-o-L V"ee �"j)rt+9wa��Jicad <br /> d 7n�nu/Le vta�ilr �o ala n .Sl�'�✓'bv S,1,�/(� �Ij i � t EN© , 4 aey/a. 5 <br /> 16 as <br /> 1 1171, u 4(i1, TI-V Cob <br /> Ta�L� iK ?„_C»ll nu! a2 ieE. rrn g ?ttt 23 , 0i'V1-9rm <br /> S lc jti a s <br /> -aLV 41r/( bC 50 rco (� 152— <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH o5 oe Rcv u99 _Correct CONDITIO.N(S)? _Logged in LAND USE BOOK? <br />