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Pte, <br /> I <br /> NOTE: PULL ALL PERNIKS (SEPTIC, WELL, ETC...) i.__iXE COPIES FOR FILE <br /> LAND USE REPORT APP# L/I -O/- <br /> S�} � 82� <br /> EHD RECEIVED APP.ItEFERRaL: COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: 110E fou" & Y- <br /> SITE ADDRESS: 7� -Z:2L S �g Gv1 �ro� � �nD <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, locatio of use, wind direction, etc.... <br /> Public sewage: <br /> Public water: —�— <br /> u <br /> SUMMARY OR COMMENTS: <br /> 127- ISD <br /> zh <br /> G` <br /> dJ- Z <br /> if i <br /> I recommend: Approval DenialContinuance Inspector's Signature <br /> / ter <br /> �F�c�Yicic�Fx�c�c�'c�F�c�c�c�4�4ic��cnF�cx�'c�'e�c�e�'c�c�c�c�c9c9eir�'e�c�e�'e��F�4dc�'cicicicic�'eXxia�r9cdc�4�'cicic�cie�c�'e�"c9cde�c��cicie*a'c9c�dc�'cde�c�c�c�"e�c� *9c�'ex�cx <br /> Supervisor/Lead Senior Comments: <br /> Ob III jj1111) <br /> -S -T C <br /> - <br /> AA <br /> J <br /> L � � <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 />