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NOTE: PULL ALL PERK rTS (SEPTIC, WELL, ETC...) IvrAKE COPIES FOR FILE <br /> LAND USE REPORT APP# �& W a A&J) <br /> EHD RECEIVED APP.REFERRAL: 5A COMPLETE & SUBMIT BY !j// y/—G.3 <br /> DA/FE DAT <br /> ATTN: //'�w <br /> SITE ADDRESS: L . <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 /> Gam / rJze2G ,1 Lc' 7�'/ i��•�/�S��i:Y 7lC // ��)Ct 'dam GG�yc L_GG l4G�) <br /> �) � �la' �/ 332�Z/ CCzsa� >.��',f� �12/r7 Sl�lci�/7 ✓C �J�LS�fir��kc'ilarn�zl ,tX1 C�c�LriL <br /> i <br /> 07 Y <br /> Al� �'�' <br /> 3) /Y� �-�i�v ��1T�.✓/��� 6/�Y ������5 ll C�� ��/� �l•��l•�lzs Lt -fes .CC7�'� Cv <br /> 2Z t� ,., �1 1�=rte /��i7 �,✓�s irk �� <`�- moi/ r�'� i•✓ <-mss <br /> I recommend: Approval V Denial Continuance Inspector's Signatu <br /> Xic is�cx4c is is icxxic 9ex�c*ic�Fxxx�czx�c:cxxic icx�c icx�c�c icx^.'c�c�c sr F�c irxXie is�c is "c�c 9c�c it is icxx r.:ex>c�c�c irx:'cxic icxxic:c�c icxic ie�e ie icxic�c�e irx <br /> Supervisor/Lead Senior Comments: <br /> -k 7tW <br /> J �� �V <br /> ,l't'i"`���V.�"V.o <br /> SUPERVISOR/LEAD SENIOR APPROVAL: &n ,,l <br /> ; i <br /> ? 0.9 II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 /� �of��'�&Lr Correct CONDITION(S)? Logged in LAND USE BOOK? <br />