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NOTE: PULL ALL PERNMS (SEPTIC, WELL, ETC...) SAKE COPIES FOR FILE <br /> LAND USE REPORT APP# j P- 9 9 -/9 (1'e //c.,,17 <br /> EHD RECEIVED APP.REFERRAL: U —Il v q COMPLETE & SUBMIT BY Wj* Map 1W <br /> DATE DATE <br /> ATTN: G i L)0/n a- <br /> SITE ADDRESS: 1070 6 . S�- . de-J-. 1 :D01 <br /> �Irla n ea <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 /> AiN <br /> < 8 PCQ)Vl0 Dt4v,,o i <br /> 1I- 0- 09 � c <br /> r ' . o i <br /> 3. C �z.o(T) 3 <br /> . ol <br /> p ;za • va- <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> .4LL��Z4 <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFA LIST: roofread report? Correct LAND USE#? <br /> E11 06 06 Rev 1/99 _Correct CONDITION(S)? _LZtogged in LAND USE BOOK? <br />