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Jy <br /> NOTE: PULL ALL PERMrfS (SEPTIC, WELL, ETC...) AfAKE COPIES FOR FILE <br /> LAND USE REPORT APP# 5A —e a- q-5 SIS e�f' <br /> EHD RECEIVED APP.REFERRAL: .3 -i d "oI COMPLETE & SUBMIT BY "/ - -3 - Q <br /> DATE DATE <br /> ATTN: .ILVI fflye 0 e r <br /> SITE ADDRESS: 1 6 tj _3 I J.l,uae_,( L-C)d ; <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 /> PREVIOUS j,/V br'rtorUs 72 ,l?Ew1,41fzJ r/Y 170`7e, <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> 3 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST., Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 _Correct CONDITION(S)? Logged is LAND USE BOOK? <br />