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r N,\ <br /> NOTE: BULL ALL PERM. . (SEPTIC, WELL, ETC...) 40KE COPIES FOR FILE 1 <br /> LAND USE REPORT APP#IIL�-CX�- ,�l LA-00-L1/ <br /> EHD RECEIVED APP.REFERRAL: _'S -0b—QU COMPLETE & SUBMIT BY (CJ' �f✓r�iLJ <br /> DATE DATE <br /> ATTN: k4 ; �JGn2C, > <br /> SITE ADDRESS: y/ L/� / � P& Z c n a *)ck 4y-\- <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 /> 02 h <br /> r Ll�l - y4d / d <br /> �- z 2. 6,E <br /> -2 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> 9e 9e�e�r�e�eie�'c�49cieie9rx�c�F*ie 9c*�cie*de ie�r�edr�k9e9c�F9cxie9c�rie*�e�e�e�c�F�e9c�e4e�e9e9c�ede�k�9c9c�r�cie9exie�"cx9cic�E�c4c�c�+e�c9c 4eic�eie*�4�c4e�e�eir�Eie9cie <br /> Supervisor/Lead Senior Comments: <br /> MS Q <br /> . e , <br /> tz <br /> w 0 0 0 <br /> n <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND iISE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE 30OK? <br />