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/11C <br /> NOTE: PULL ALL PERS (SEPTIC, WELL, ETC...) 111KE COPIES FOR FILE <br /> LAND USE REPORT APP# (��� -r✓' - S ��,(� V <br /> EHD RECEIVED APP.REFERRAL: ` ( 0 Z COMPLETE & SUBMIT BY <br /> DATV I DATE <br /> LLC-6e, sATTN• <br /> SITE ADDRESS: D 2 S (= ��( J q ,S -� <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 /> _� G�c�G/�iii1J�=����j/i�u93 LG�7c�/•�i�,�#27i?.23�37/fiG�'��� . <br /> -rte�/�-�z •.5f� G/�G:�S.�i�c�//�3r��zy• ;��5 �����a���� <br /> — <br /> c� <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> iriciciricicicxicicic*icicixxxiciciczxicicicxic�cxicxicx�cicicicicicxxicicxic�e�49cic9cx3cic�c�eicicicxic�cicici�ic�cicic9c�Fie�'cx�'eic�c9cicicieieic�cic7ciric�cicic <br /> Supervisor/Lead Senior Comments: <br /> 0 7 611 <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />