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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# a <br /> ,q 4,o r4� <br /> ao1 n� COMPLETE & SUBMIT BY / J.S� I� -S" 0 'Q l <br /> EHD RECEIVED APP.REFERRAL: D <br /> LLAT ATE <br /> ATTN: <br /> �✓ al <br /> SITE ADDRESS: j5 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 /> Supervisor/Lead Senior Comments: <br /> w <br /> C Rol <br /> Gu r� <br /> r <br /> SUPERVISORILEAWSE IOR APPROVAL: <br /> Y <br /> e� r� Correct LANDS USE# <br /> OA II CHECK OFF LIST - Proofread report?, } <br /> Carre�lCONDITION{Sj? 'Logged fn�LAND USEUOIC? ; <br /> F 11 06 06 Rev 1/99 <br /> t <br />