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4 <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: 1 COMPLETE & SUBMIT BY 0 -Z—C7R <br /> DAIE DATE <br /> ATTN: L <br /> SITE ADDRESS: bf, O�C�.(/J/��r�•C71J�C r <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 Signature <br /> *******ar9c�'t*�c�e*�ckF�c*tF*�e*dc***vk9ea�edrx$kdc*�t'.Ec�ek*is*�c9t*fir*x�e*vF**dt9r�cFx*x*vcdtxe do****x9c*aFdeJr*$rE�c!c 9e 9e 7kk�ex'rr* <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> „ ,. W ''Correct LA&D [ISE#y, : <br /> OA II CHECK OFFLlST � ,. . Proofread report ; r <br /> ` Correct CONDI TIONS)? = L`ogged fn LAND USE SDOIC : <br /> EH 06 06 Rev 1199E <br />