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NOTE: PULL ALL PE MITS (SEPTIC, WELL, ETC.-.-.1 NIXKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: 01/03 COMPLETE & SUBMIT BY v <br /> DAT11 l AT <br /> ATTN: -9C <br /> SITE ADDRESS: a 3 a y l� c�Yl d -JZc`�fjt� �-or� 1 <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 /> P�"4in <br /> /J-/- d_3 <br /> 1""M of ell , M e <br /> �/ <br /> ll tl on T� et -J c int q <br /> r if <br /> 12 :5411 <br /> ZZ-Utf - /10� Gf%��t'r •�ttirlr:�li �� ��=! ri�� a 6¢; �;* �: � 1� <br /> / <br /> I recommend: Approval_ Denial Continuance Inspector's Signature-,�� <br /> �c aF�kxi�*icx is i��cxx�tx�c:c�c is irxxxit sc 3cx�'cxxic�c icxxis icx xic is is is�c yc is�'c is is is xirxic irxx�c ix is�c icx is 7c�c is is icxicxzir it is icxxicx is �xx9c Mfr tk�k 9r <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA 11 CHECK OFF LIST.• Proofread report? Correct LAND USE#? <br /> E1106 06 Rev 1/99 Correct CONDITION(S)? Logged M LAND USE BOOK? <br />