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LG <br /> NOTE: PULL ALL PERATs (SEPTIC, WELL, ETC...) M%KE COPIES FOR FILE <br /> LAND USE REPORT APP# — ,3 —5611�JI_0) <br /> EHD RECEIVED APP.REFERRAL: 4/a3COMPLETE & SUBMIT BY 311 <br /> DA / DATE <br /> ATTN: t n /Yl �JN //g/- <br /> SITE ADDRESS: <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 /> v <br /> -A4 <br /> .S W,6 <br /> v <br /> I recommend: Approval Denial Continuance Inspector's Sim r4'� <br /> icicicicicicx�cirxicic�c�cicicic�cirir�c�EaR�F9ricic�+c�r�caF9c�c9c*�F�e9r9rx9c9cic�eir4c�k�e�c9c4cic�Yic�c�e4cie�'c�+e�e�c�cicir�Y ir9e*x'xicQe*�c�Icdejeie�e�Y9e�Irdea��c <br /> Supervisor/Lead Senior Comments: Z, -t- �� '�'"°" f °- <br /> ? 6 -. ... <br /> f <br /> �.. �. <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />