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• • , t` <br /> NOTE: PULL ALL PERNAS (SEPTIC, WELL, ETC...) AKE COPIES FOR FILE ( / <br /> LAND USE REPORT APP#_SCJ--01 - ( Q <br /> _ 06-klbre <br /> EHD RECEIVED APP.REFERRAL: -O l COMPLETE & SUBMIT BY &1910 3 -r a--c7I <br /> DATE DATE <br /> ATTN: rW c II,1)411 P,t.l l �' "�,� / <br /> SITE ADDRESS: 17 q 5p S. ✓ari E llen , , („SCA O <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 Signature <br /> Supervisor/Lead Senior Comments: <br /> V <br /> J,e Of 1 <br /> A 11 13 <br /> 40 SS�EffD <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECKOFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />