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It <br /> 4 t� <br /> 1'40TE: PULL ALL PERlV, fS (SEPTIC, WELL, ETC...) N. ,KE COPIES FOR FILE <br /> LAND USE REPORT APP# D 67-6-) <br /> EHD RECEIVED APP.REFERRAL:;� —/� COMPLETE & SUBMIT BY —/ —03 <br /> DATE ``, DATE <br /> ATTN: �- n i1 y- 1 ► l,,n 041lE <br /> SITE ADDRESS: 00 a00 IVA i it h - d %fly <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 /> �c 9r is is is 9cx�c is 4c�cxir�c is iaxic�F�c icxic is is icxic is is is icXic is is is it is icxic is is is rc is 9c icxic is�k�c oc is it�c�4 is is is is irx9cxic�c**�9r ie ie�F ie�ex�49e�e�e��c x�c 3c 9cx <br /> Supervisor/Lead Senior Comments: <br /> ZZ <br /> SUPERVISOR/L.EAD SENIOR APPROVAL: 4 <br /> OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> Ell 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />