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Y --! Q~TE: PULL ALL PER*ITS (SEPTIC, WELL, ETC...)'MAKE COPIES FOR FILE <br /> T i <br /> LAND USE REPORT APP# CY� S - X15 -O_q T 1 � <br /> EHD RECEIVED APP.REFERRAL: ]- aj( / -qq COMPLETE & SUBMIT BY - — <br /> DATE I I DATE <br /> ATTN: _r,rl` n 61 + 1, r 1 C C A <br /> SITE ADDRESS: % 0 7v5 C) <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: I't161t,c Public sewage: Ak-vv <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> *xir Tr�c>E fc it*i�icxic is is is is is icx�c:cic*:i�c>cxxirxic�c is is is*ic:<ic ir>i is icxic is is is*xix is it ic��*iic is�c is is is�c�c ic:F:i�F:ix�czir xic is i�ir�c<ix is�c x�c is is <br /> Supervisor/Lead Senior Comments: <br /> • l � <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 00 06 Rev 1/99 Correct CONDITIO.N(S) Logged in LAND USE BOOK? <br />