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. , LV <br /> :*'PULL ALL PERMITS (SEPTIC, WELL, ETC...) M-AKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: ' q-oo COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: x I aft-&-�- <br /> SITE ADDRESS: ](� A <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 /> /� I. Mulau.5 7-z> k&"0/*v V-Hle- �E9 <br /> 47 <br /> X72.—07� w9- 2 S&PP&-y. <br /> 3, 7ND Mrs 1-t.1 76 w41�ir &k NVw}r�C <br /> �• ��_p � $�E Kr�l�I n� An��a►�b }'"�-N 7�5 ��r�R ,���'a+��Troru ��'SrR�c7x��� <br /> /N,;v1do !3 f>U rlII <br /> U Z -- Ha F rTian. c4 L)4,+9 PIL-PnW 5 7-R wrn-R,*_5 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> rb <br /> r Q 722 <br /> � Q <br /> i <br /> .62 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA:II effk OFF LIST € XProofread report? 'Correct LAND U.S #?, <br /> Eli 06 06 Rev 1199 k4 Cc►rrect CONDI7ION(S)? Lagged to LAND,USE BOOK. V, <br />