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v l,/ <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> �N <br /> LAND USE REPORT Am S - 19 -V/ <br /> rr�]C� <br /> EHD RECEIVED APP.REFERRAL: .,� COMPLETE & SUBMIT BY a <br /> DATE / JDAT <br /> ATTN: ka; ,4JC/� <br /> SITE ADDRESS: f 17,51 r. S�--, le h 1 , T1/4 C,7'Dt' <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, n?l dire'nop, c ... <br /> Public water: u Ie se age: <br /> SUMMARY OR COMM NTS: <br /> v � <br /> Cc- <br /> I recommend: Approval Denial Continuance Inspector's Signatur��,� <br /> Supervisor/Lead Senior Comments: <br /> 1 <br /> IVA/ - <br /> 3. ida- oy <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 17 CHECK OFF L/ST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1199 _Correct CONDITION(S)? Logged in LAND USE BOOB? <br />