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;M1 <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: J �0� COMPLETE & SUBMIT BY �S� � �o- a 3 -Do <br /> DATE 1 DATE <br /> ATTN: -1 .f S S + <br /> SITE ADDRESS: fl a� (—�' ' r-)'11 t (Z'CL <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 /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHEe]�€OAF LIST` Proofread reportP Correct OND USE <br /> �n M <br /> l <br /> EH 06 06 Rev 1/99 ;r ; Correct CONDITIONS)q loggeLAND SSE$OOK� <br /> 2 <br />