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J l.4 <br /> -NOT)E: PULL ALL PERn*riTS (SEPTIC, WELL, ETC...) i TAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL:DAT1 COMPLETE & SUBMIT BYE U .3 <br /> ATTN: Nk4 L% <br /> SITE ADDRESS: $ Jr" 7 LCAy 1z <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 /> ! �J/ � � c� � .',a c.�,y<-u.�.4. /c6;f'r. ,r" �- i�+••l ptt,c�y,'�,Cl'"rsi._ � ,j�?, ,�1 .� �.. <br /> 09. <br /> Alt <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �c>c�Y�c is xic�cxirx9c 4cx�c�'c 7c�cx�c�c�'cxic>c icx9c 9c is 7c is irx�c�F�F ix r'r 9c is X7c iczx�c is is is�c�c ic>c is r.is xix�c is�c�cx r.icx�c�'cr.x�c icx X�c icx icxisx is is�c is icx>'cx <br /> Supervisor/Lead Senior Comments: <br /> �. <br /> c1 'C.Q /y� •. <br /> 2,7 <br /> .2 2ro <br /> SUPERVISOWLEAD SENIOR APPROVAL: _. <br /> e'- <br /> OA H CHECK OFF LIST.• Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />