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i <br /> d. <br /> m <br /> NOTE: PULL ALL PEI YTS (SEPTIC, WELL, ETC...j AKE COPIES FOR FILE <br /> LAND USE REPORT APP#_ M S— Q 1- 19 <br /> EHD RECEIVED APP.REFERRAL: `r -1 °'7 -0 a COMPLETE & SUBMIT BY 5 — -7- 0 q <br /> DATE DATE <br /> ATTN: �] 2i'1(�1-Fer �c7I (Ey <br /> SITE ADDRESS: 13 S , C_ft <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 /> Of <br /> all- <br /> v <br /> _ I <br /> - . <br /> I recommend: Approval Denial Continuance Inspector's S' , <br /> iric�r�r�c�kkkati�'c�Y�'ekx9c�t�tir���Ek kaF-Jc�ricis�c9c3c*�F�4is�e4ek�Fxdrde�c$eJc�e�x3tx9caFac:Fic�ckic9ck�cFck�kix 3c 9c 9c�4�e'ic**�Fk��e�Y�ck�F�ck9e�e�'cie <br /> Supervisor/Lead Senior Comments: <br /> D . Cl : o3 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> "OAHCH€ ECKOFFLIST ''..Pravfreadreport� Correct LAND USE#9" <br /> EH 06 06 Rev IJ99Correct COND[T'IONM ; Laggerd tri LAND USEBDOK� <br /> Y F R zs <br />