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NOTE: PULL ALL PERNS (SEPTIC, WELL, ETC-) \KE COPIES FOR FILE <br /> LAND USE REPORT APP# E14 — 0o) - � <br /> EHD RECEIVED APP.REFERRAL: 1 —Oa COMPLETE & SUBMIT BY 52 — /F`"Oa <br /> DATE DATE <br /> ATTN: kel si V <br /> SITE ADDRESS: 5000r mr f" ,Sh GAG <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 /> 4 <br /> SUMMARY OR COMMENTS: <br /> i <br /> i <br /> I <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> /� <br /> v � <br /> i <br /> I <br /> } <br /> f <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II(4&CK OFF`LIST g, Proofread report? �'`Correct LAND:USE#P <br /> EH 06 06 Rev 1/99 �� Correct�ONDITION(S)T ILW '' Logged in LAND USE BOOK? <br />