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SS <br /> DOTE: PULL ALL PERA rs (SEPTIC, WELL, ETC...) i1rAKE COPIES FOR FILE <br /> LAND USE REPORT APP# 514-01 -6o o <br /> FAR)RECEIVED APP.REFERILIL: O 1 (4-V/ COMPLETE & SUBMIT BY V— 0 <br /> DATE DATE <br /> ATTN: 1a j /} I Ue <br /> SITE ADDRESS: 1 -7 Y a-17 ik) On 5c,,s k,,, l2 iA <br /> t <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 /> --�(IL�W lMwovemvazz ZL /N �f J —y7 ili�� LG�fI?7l1RiS ` <br /> j�(j,L.Qg fa <br /> I recommend: Approval Denial Continuance Inspector's Signature � , <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: _ <br /> OA H CHECK OFF LIST.• Proofread report? Correct LAND USE#? <br /> EH 0606 Rev 1/99 11 1 <br /> Correct CONDITION(S)? —Logged in LAND USE BOOK? <br />