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i NOTE: PULL ALL PERMITS {SEPTIC, WELL, ETC...} MAKE COPIES FOR FILE <br /> I <br /> LAND USE REPORT APP# <br /> re <br /> EEYD RECEIVED APP.REFERRAL:_q/Z/qQ COMPLETE & SUBMIT BY <br /> D E // DATE <br /> ATTN- <br /> �• !' <br /> i SITE ADDRESS: fY10 4 <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 /> 1 <br /> c <br /> 0 6 oe rcprxAAd <br /> De <br /> L <br /> 6 b �� G 041 <br /> I recommend: Approval Denial Continuance Inspector's Signatures -- <br /> Supervisor/Lead Senior Comments: <br /> y <br /> J1 i� <br /> i� <br /> f FI <br /> i <br /> Y <br /> ii <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> �� !{ �OA II CH�C1�D FIST _ ���'roafread repod?; � �Correct LA1VD USL:#' <br /> EH 06 06 Rev 1/99 y" ' � � Corxert CDNDITIOIY{,S)?, Logged rn f. ND USFB40IC?��A <br /> p •��x ?� �"rw+• +",5't;. ?. �a.'fr � ..•"r''t: .i.i �,Y ,�3 <br />