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NOTE: PULL ALL PERMht'S (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> r„J <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: v-,)6 q COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN• TC:rr rl <br /> SITE ADDRESS: j a 6 - lqzs f / [ ,� 91 A-114-ca <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 /> n ` <br /> k <br /> &&�--41�- - <br /> I recommend: Approval_..ZDenial k Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> 4 <br /> f <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> DA II CHECK LXST ooftea4 reports, Correct LAND U.SE A. <br /> Eli 06 06 Rev 1199 a Correa EC(1NAITION(5�9 `� _ f ogged c TJ USE Prl1DK7 <br />