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NOTE: PULL ALL PERM -fS (SEPTIC, WELL, ETC...) M: KE COPIES FOR FILE <br /> LAND USE REPORT APP#_�� <br /> a EHD RECEIVED APP.REFERRAL: I—Ohylo:3. COMPLETE & SUBMIT BY - 0-3 <br /> DATE DATE <br /> ATTN: j r2,C 2 ieo in -e 5 <br /> SITE ADDRESS: <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 /> Sl- <br /> 141 <br /> a. <br /> 0 <br /> ecammend: Approval enial Continuance Inspector's Signa mac. <br /> Supervi or/Lead Senior Comments: <br /> a <br /> w , Q <br /> Vn. <br /> �. <br /> t 11:x`3 2 <br /> SUPERVISOR/LEAD SE O PPROVAL: <br /> A0 <br /> �. OA II CHC O GIST: _ �Proofre�rd rep'ott? "° :Correct ND USE#9 <br /> ��"^� t o6 0�€tEv ��99 " € _ "Correct COt\�DITION(Sj - Lagged t�LAND�US BOOKS <br />