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r'N <br /> ' NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MhKE COPIES FOR FILE <br /> r : <br /> LAND USE REPORT APP# S / <br /> EHD RECEIVED APP-REFERRAL: "'31 J COMPLETE & SUBMIT BY — o'Z 1 0 <br /> Q <br /> DATE DATE <br /> ATTN: _I <br /> SITE ADDRESS: Yom?OHO S-, Cj�._ <br /> In completing the Land Use investigation, draw.all Public Health factors on the exhibit (i.e.: sewage disposal, <br /> p g <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 CO MENTS: <br /> _- 0 0 2 <br /> zo <br /> I recommend: Approval —z Denial Continuance Inspector's Signatu <br /> Supervisor/Lead Senior Comments: <br /> 0 <br /> 0 ew D <br /> SUPERVISOR/LEAD SENIOR APPROVAL: 7 <br /> 161 <br /> L ,� <br /> OA lI C�EC`K[1F�F'LISW � Prvafread reparf ,�« , �= orrect r�'D�5'E# � <br /> a5 ; <br /> fit <br /> EH 06 06 Rev 1199 `�C01 t CCS CONDITI0IV(SJ P € Lvged L rt�VD USE BOOKS <br />