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led <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# T 1q -Q0-yg1,0fj-Do-ria <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY - 5 --Q,�) <br /> DATE DATE <br /> ATTN: Lsr 50 //it U rt <br /> SITE ADDRESS: W 00 5 . 47,-rear <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 /> 4 <br /> e. . <br /> a <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments- <br /> SUPERVISOR/LEAD SENIOR APPROVAL: Q <br /> g'OA liT <br /> CHE -X FF, Prvofred eport� �Y Corieci Li1ND ITSE# <br /> �� Gorrecl GQDITIQII�{S} ', Logged int GA1VD USE BOOK <br /> EH 06 06 Rev 1149 � <br />