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L C- <br /> NOTE: PULL ALL PER-N,-S (SEPTIC, WELL, ETC...) -_,iKE COPIES FOR FILE <br /> LAND USE REPORT APP# Oj �s'jq <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY <br /> DATE — <br /> ATTN: DATE <br /> �. <br /> SITE ADDRESS: 13 ?� 1 `5 f . f.f- o/ V ) <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 /> f <br /> I recommend: Approval Denial Continuance Inspector's Signat , <br /> �c is it 9c is icxic is icx�cxxyczc 9c*�c�F�c>cxxxic:c x�c icxxicxxicxxic�cxa��'c�c 7c�cxcxc is�FXxic E F�c is�'c icxFxxxxxx*�cx �c X>r�c xicxicxxickxicx <br /> Supervisor/Lead Senior Comments: <br /> oy <br /> .� �1� 0,1.z — <br /> � . D <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> t <br /> OA 11 CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> Ell 06 06 Rev 1/99 Correct CONDITION(S)? Logged it:LAID USE BOOK? <br />