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v T� <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...)VAKE COPIES FOR FILE <br /> LAND USE REPORT APP# �%� - �/ - 3 <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY 5 -13-99 <br /> D E DATE <br /> ATTN: <br /> SITE ADDRESS: J51351:5- 1711 ,5j-1 /eY-1 C . I� �e0�. , /�-C M2�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: �1� (4 �- Q Public sewage: A�hz /pe,- ..e z,�,e5 <br /> SUMMARY OR COMMENTS: 4.4 <br /> 0 ZQ, a� <br /> 20 . <br /> o �- <br /> 2 <br /> I recommend: Approval Denial Continuance Inspector's Signatur;1100�-- � <br /> Supervisor/Lead Senior Comments: <br /> 1)4�4, zkl A1,4 <br /> � bv,.eeo, Zeiyd iii ,y <br /> T <br /> 4 SUPERVISORILEAD SENIOR APPROVAL: Ifffry <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 />