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NOTE: PULL ALL PERST7TS (SEPTIC, WELL, ETC...) NTAKE COPIES FOR FILE <br /> LAND USE REPORT APP# F1q o-5 - C QS`31 --AbAF-bY' <br /> t � <br /> EHD RECEIVED APP.REFERRAL: / COMPLETE & SUBMIT BY ` i 123 <br /> DATY DATE <br /> ATTN: Y <br /> SITE ADDRESS: <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 /> U YV 0A nr <br /> a�r,�.� A S C1 <br /> 'sQA\ ta, U r ^�bl� vo-f A-- <br /> Tf= zz <br /> fir <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor//Lead Senior Comments: <br /> Ll cllall� <br /> 11 -07 <br /> J <br /> U <br /> SUPERV OR/L D SE IOR APPROVAL: <br /> OIL— <br /> OA 11 CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> /�,�EH�06 0J6/',/{�{�/��v 1/99�/� Correct CONDITIO.Y(S)? Logged in LAND USE BOOK? <br />