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NOTE: PULL ALL PERN22r,S (SEPTIC, WELL, ETC...) N"dCE COPIES FOR FILE <br /> LAND USE REPORT APP# MS - �iYdo, <br /> EMD RECEIVED APP.REFERRAL: I COMPLETE & SUBMIT BY—/ - c2 - 01 <br /> G <br /> DATE DATE <br /> ATTN: n d le.( /Y1 a r z'n <br /> SITE ADDRESS: 9031 54—• 2 t- . -7:!kv id, L�Wy�) <br /> ,r <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 /> re <br /> I recommend: Approval Denial Continuance Inspector's Signatur 1 <br /> Supervisor/Lead Senior Comments: <br /> ' le�l <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: _Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />