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T/\/ <br /> NOTE: PULL ALL PER1V>rfS (SEPTIC, WELL, ETC...) IrtAKE COPIES FOR FILE <br /> �e�Jr�c <br /> LAND USE REPORT APP# 54-01—cy <br /> EHD RECEIVED APP.REFERRAL: Y-3-0 COMPLETE & SUBMIT BY (A "( g --(-DATE <br /> ` DATE <br /> S / <br /> SITE ADDRESS: l l g 9�qz n1 S4— le-t- q01 6 <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 /> z 7" dc,x 6,zolzll 2 <br /> rw <br /> r <br /> I recommend: Approval OO'rDenial Continuance Inspector's Signature <br /> 4ra'r�t r'x�t�E�c��c�cx�c�c 9c it fr�c�c�c*9c*9c�c arc*�F*4c�`c�c 3c�r�r 9c is*4c�r�Yx4r$c�k ar 4r�r is*�c 4r�c 4c*aFx*�c�c�c**4e�c 3c dr�c ix�c�*�c�c is is do�t 9c�c�cxxis isxxic irxz <br /> Supervisor/Lead Senior Comments: <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 in LAND USE BOOK? <br />