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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC-) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# [-/1 - 00 -43 <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY v <br /> DATE `A DATE <br /> ATTN: �iO 6 OA <br /> Ltn-gis t-C.r <br /> SITE ADDRESS: _ 7 (A Cr <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 Signatu 1 ' �.v <br /> Supervisor/Lead Senior Comments: r� <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA IJ CHECK QFC LIST `� 'F ' `Praofread report? �` � Correct LAND USE#9 <br /> EH ob ob Rev i�99CONDITIO}1'�SJ 9������ Logged Iri LAND USE BL70K�` � <br />