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NOTE: PULL ALL PERN�,fS (SEPTIC, WELL, ETC...) i..;AKE COPIES FOR FILE <br /> r <br /> LAND USE REPORT APP# L - - ys <br /> EHD RECEIVED APP.REFERRAL: 7-1q-1q COMPLETE & SUBMIT BY A / ! ,0 — T7 i�Y�L7� 9� <br /> DATE DATE <br /> ATTN: 19141_17/7 <br /> SITE ADDRESS: —h ,1 A . QY:DIQ Ln Ct <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 /> I recommend: Approval Denial Continuance Inspector's Siatu <br /> di>'c*****�e�ek:F*k�e*k*:E*****fr�le�'e�e�e:F:Fviek'eie*ate*keY*ic*:k�ecifrak:Fde*�e�rkvk:lr*ak9e�t�fr�'rcir***fir*ir4lrle�e�tie**�rvk�rirkieseie5't�r�c* c <br /> _YYYJ;�/�z�� <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECKOFF LIST.• . Proofread report?' Carred LAND USE#? <br /> Ell 06 06 Rei ii9e <br /> Correct.CONDITION(S)? Logged in LAND USE BOOK? <br />