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NOTE: PULL ALL PERZTS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# . 51q - <br /> EHD RECEIVED APP.REFERRAL: Jqq COMPLETE & SUBMIT BY <br /> DA 4ATE��/ 99 <br /> ATTN: t7rV1Gi <br /> SITE ADDRESS: ✓)1GkQ1Utnn(-- ' oo d C1 11A <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: yc� - Public sewage: l/ zv-5- <br /> SUMMAR OR COMMENTS: <br /> f4 'n — Q <br /> Cn <br /> l <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> n(A' <br /> �f) -Q� <br /> lsz, - oa <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA 11 CHECK OYF LIST.• Proofread re rt? Correct LAND USE#? <br /> ev <br /> EH 06 06 R1/99 V Correct CONDITION(S)? �l Logged in LAND USE BOOK? <br />