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f'ti'15 -00 <br />+ NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...} MHKE COPIES FOR�FILE <br /> Y, <br /> LAND USE REPORT APP# Vle -Uy — y <br /> J . . <br /> EHD RECEIVED APP.REFERRAL: /0 COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: ,�� `/ ' <br /> SITE ADDRESS: _/y� N �Ah3n2r' -r'✓"( �i0e- U4412, <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 reap of area <br /> showing population density, location of house, wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> G ' <br /> 1 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> w <br /> S. <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> DA IT CHECC(1FF'L'IST � ' Pr'aafread report?' Correct SND ilSE# <br /> EHl}606EZevU9q '� �"kEorrectCQl�'DITIO (SJ € LoggedlreLAND+USEBOOI7 <br />