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�y <br /> NOTE: PULL ALL PER%TS (SEPTIC, WELL, ETC...) ".EKE COPIES FOR FILE <br /> LAND USE REPORT APP# PA- -o a --a <br /> �O��3 O z b RAY ON VACATION <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY e �j/ ' 7/1 /q/02 <br /> DATE DATE <br /> ATTN: )'e-e nn e- MUe (le (- <br /> SITE ADDRESS: Z16� g 5 , 1-w rrI / )n /CA . . � Orn (Yl� <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 /> O� <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> r7;7 CHECK OFFLIST.• Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct COiYDITIO:V(S)? Logged in LAND USE BOOK? <br />