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NOTE: PULL ALL PEPM.,. S (SEPTIC, WELL, ETC...) i,-AY---E COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: -DJ{A COMPLETE & SUBMIT BY <br /> DA E DATE <br /> ATTN: :1 C,k- <br /> SITE ADDRESS: l I U � I t. . LnA . <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 /> Tfl�w; "l[1�_1�vC_�7._f''/ <br /> �L ✓��+ycWe �� 7►' �^4t- Ui(.'Sit/�.e[AmI eY° ..+^'F.F.F �e'7�:-Q <br /> ..u+tIYWM Q4/H'•'Q� +�,%Its � //// <br /> I recommend: Approval Denial Continuance Inspector's Signature f <br /> i <br /> Supervisor/Lead Senior Comments: <br /> ® 1 <br /> ce- <br /> I Jho �� it <br /> SUPERVISO EAD SENIOR APPROVAL: <br /> 77 <br /> Z k OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 f(_� Correct CONDITION(S)? Logged in LAND USE BOOK? <br /> J ��• Cly'".`' �, ,,X�nr. . , <br />