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�v <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) TMAKE COPIES FOR FILE <br /> LAND USE REPORT APP# Lt P :- 3 I -OS ( •'� - ice <br /> EHD RECEIVED APP.REFERRAL: ✓_to -y/ COMPLETE & SUBMIT BY 2 ---29 -01 <br /> DATE DATE <br /> ATTN: i y -0 L �-,) <br /> SITE ADDRESS: 740 S. P G�C�SyL f_T� C . <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: �lP�C C <br /> SUMMARY OR COMMENTS: <br /> 1 = 0-7 <br /> d li <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �r�t*it*Fxir"c*F�c*�cx*fir�cx�c**�c is F�c F*4c*x�F�c�r is is YxscxrcxF*x*irx�c>c is is�cxxic�cxx�c�c icx xxic is ix is icx ac arxxxicz�c ix�t �F icxicx xic <br /> Supervisor/Lead Senior Comments: <br /> Q <br /> lI 6 <br /> �( <br /> 0. <br /> C- o <br /> I / <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EF1 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />