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r <br /> NOTE: PULL ALL PERMS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> -LAND USE REPORT APP# 5,4 - q9 - q? <br /> ')*ft5^ P <br /> EHD RECEIVED APP.REFERRAL: °� "1O y 9 COMPLETE & SUBMIT BY / A- a 9- 9 of <br /> DATE DATE <br /> ATTN: ✓otnai <br /> SITE ADDRESS: LjC 4 fj tS�S}- !e-i-, 9 9 6-- 46:�;nl d.) S f»c&fu) <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: AJ 7� <br /> SUMMARY OR COMMENTS: <br /> l <br /> A <br /> / V J <br /> TZO 64c <br /> Ae) -17 ✓&pati cy! +9 <br /> /WP <br /> 1'02oLfZ. <br /> I recommend: Approval <br /> _,2i)enial Continuance Inspector's Signature <br /> Supero R a c _Comments: <br /> 02 If vlpr�K wtt5 � <br /> nd"iyal <br /> p9 � d�s.atcr q tred, they must be plumbed through asand/oil separator andddischarged to <br /> an above ground system approved by the Environmental Health Division. A registered engineer <br /> must design this system. The material collected in the above ground holding system must be <br /> analyzed for hazardous constituents prior to disposal. Specific test requirements may be obtained <br /> from the Environmental Health Division. A $156.00 plan check fee is required at the time of <br /> submittal. <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> Ell 06 06 Rev 1199 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />