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NOTE: PULL ALL PERArts (SEPTIC, WELL, ETC...) Nj,.4KE COPIES FOR FILE <br /> LAND USE REPORT APP# - l(JP <br /> EHD RECEIVED APP.REFERRAL: / o 03 COMPLETE & SUBMIT BY <br /> DA DATE <br /> ATTN: A <br /> SITE ADDRESS: dl .iron rJ <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: P P blic sewage: <br /> �G <br /> SUMMARY OR COMMENTS: %ZVL., <br /> Sb <br /> V���/�ii/Yfit U/1cceGK-Off/ <br /> bY..�JI Ta.G4/!!J ��®rrfi�, �7.�r��`-�/" r-dAo_✓Jsai ,eAc T/.fulfil <br /> �ie/15 0�/t��'C/' ii•��9G/�IY�T '✓/�/J�IJ r7�fl�t�sltl�`ac�sfrr <br /> 1111 <br /> � - ..�lJ f3tD..$�'i•= 3 1 7ZD3 lI��..o7u/..✓F-tcU,rutLtGll:7.S83!�i- <br /> _ <br /> I recommend: Approval Denial Continuance Inspector's Signatu <br /> Supervisor/Lead Senior Comments: <br /> f <br /> f <br /> � <br /> SUPERVISORILEEA� CSD SENIOR <br /> r <br /> z <br /> II CHECK <br /> s CK OFF LIST: _proofread report? Correct LAND USE#? <br /> 0 9�•• _Correct CONDITION(S)? Logged in LAND USE ROOK? <br />