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.:NOTE: PULL ALL PERI*riTS (SEPTIC, WELL, ETC...)-.,IAKE COPIES FOR FILE <br /> a <br /> LAND; USE REPORT APP# CA -01 —(6 <br /> EHD RECEIVED APP.REFERRAL: -1 b;:)4-3- 0-01 <br /> + <br /> COMPLETE & SUBMIT BY R -3_ 19-p 1 <br /> DATE <br /> DATE <br /> ATTN: Mop- lie r <br /> SITE ADDRESS: go15 y s -�o 44.0.. Amine . <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: W Public sewage: -�--�4 <br /> h <br /> SUMMARY OR COMMENTS: <br /> I <br /> N <br /> N <br /> IM <br /> N <br /> I recommend: Approval Denial Continuance Inspector's Signatur <br /> ��e$x�e*$r�F�rkir&�r ie�e�'e 4t�t�e�F:E�k�r �t�ex�ex*pie ale�e�'e�r it�r�'e�r 9r 9e 3e�e�r 4r efr�F xvF nkx9e k�e 4e 4r 4e de�e�r�'c is acnic:F 3c it 9r 3c�r dr�e xir�F�c**9c dr eY' xx is it - <br /> Supervisor/Lead Senior Comments: <br /> 6L <br /> I <br /> I - <br /> .�i <br /> Ir <br /> .I <br /> l� <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> � Prao read re ort 9 z' <br /> 4A II CHECK OFF LXSx. f p Correct LAAND USE# <br /> EH 06 06 Rev 1199 ` � Correet�CONDITIONO� "Logged rn LAND USE$DOK? <br /> �. <br />