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NOTE: PULL ALL PER (SEPTIC, WELL, ETC...) V KE COPIES FOR FILE/� <br /> MS N <br /> LAND USE REPORT APP#! 41L—D--I--e22 y tme <br /> EHD RECEIVED APP.REFERRAL: G -�) -0Z COMPLETE & SUBMIT BY :Z- & -0 ;Z <br /> DATE DATE <br /> `f <br /> ATTN. �6 c r -Rt L,A A exS <br /> SITE ADDRESS: I C1 3 G(7 e . <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: <br /> 7�2 O ohn do,/O/ GrvHrIS : � e r J <br /> w j7 < Y /✓I JAP Lv SU�� <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> 14 lie` 06 + ot y <br /> o2 <br /> D �2 01 <br /> � <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: _-Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITIO:Y(S)? Logged in LAND USE BOOK? <br />