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NOTE: PULL ALL PER Y_ S (SEPTIC, WELL, ETC...) l.__iKE COPIES FOR FILE <br /> LAND USE REPORT APP# P/q- n, �� 2 <br /> EHD RECEIVED APP.REFERRAL: 0 �— COMPLETE & SUBMIT BY / v/0 <br /> DAW DATE <br /> ATTN: /� , C�- 0-��' <br /> SITE ADDRESS: oZ.30:2 fJ . 41- ������ c,/G�Gy� <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 /> ),94!3-44/C-en o c'Gh, ,-71-A, <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> FxixicicicicicccicicicicicieicXxicxicxic�r�ciekiciecicic9c�Yicrcic**Ficcicic�c**icicic�c�cic�c�cicixicxicicxcicicicicicicicxiciciciricicxxiciciciciciciric�c�c <br /> Supervisor/Lead Senior Comments: <br /> 0 y <br /> d <br /> Y2 7Y <br /> fP /0 .2 � 6 <br /> SUPERVISOPULEAD SENIOR APPROVAL: y �� <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EF106 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />