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TT <br /> NOTE: PULL ALL PER-k fS (SEPTIC, WELL, ETC...) I,.,,KE COPIES FOR FILE\ <br /> LAND USE REPORT APP# 0a - rJ3gCI J <br /> EHD RECEIVED APP.REFERRAL: Id oa COMPLETE & SUBMIT BY__1 D a <br /> DATE DATE <br /> ATTN: I—e-o,(\,(\ e— M cp e-c <br /> SITE ADDRESS: a 55 V a f� S -R A q q F <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: 111 Public sewage: -0 <br /> SUMMARY OR COMMENTS: <br /> ��s oL��' s 7``iv �i/ry� Qi .n.rr trd i✓fe i.�ilFe�s .YDL �5� <br /> r>- w o-Y in o �e c�utcnry 4-u 4, <br /> 1� 06 <br /> zz.o <br /> ,'1211 o 11 <br /> I recommend: Approval ✓ Denial Continuance Inspector's SignatuJA <br /> x**xKxx*�**xK******�;xx �x�*:�xx**xxx***xKFKxxxxFxx�x:�***xxxxxxKx,�xxxx**�xxxxx x,:xx**xn <br /> Supervisor/Lead Senior Comments: <br /> t1 .6 V�. <br /> C <br /> j/ . 0 3 �M� or. <br /> D a d1 U <br /> � 4 <br /> 19 M <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFFLIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1199 _Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />