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Tn' <br /> NOTE: PULL ALL PERP,,.S (SEPTIC, WELL, ETC...) :,_,eKE COPIES FOR FILE <br /> LAND USE REPORTAPP# / /-I - (-) 2 - <br /> EHD RECEIVED APP.REFERRAL: °2 _ 'ot `O Z COMPLETE & SUBMIT BY -3 --5 -02 <br /> DATE / DATE <br /> ATTN: <br /> SITE ADDRESS: 19 3 3'5 �, , 6u L,. ��• /�c� rt.o <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 /> /1 <br /> D (0 <br /> 3 — t t1 Q Q,Q VL bV I t~Q�n WLa S4- L,.t¢Ju <br /> I recommend: Approval Denial Continuance Inspector's Signature_ (,T XY�� <br /> Supervisor/Lead Senior Comments: <br /> t <br /> �./t ro ti {a e�Lely a-Lewr7�c,o <br /> aAA rjiaA,k LLe Q PTeyo, w 60 <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA H CHECKOFF LIST: Proofread report? Correct LAND USE#? <br /> \ Ell 06 06 Rev "9 Correct CONDITION(S)? Lagged in LAND USE BOOK? <br />