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"NOTE: PULL ALL PERMr.S (SEPTIC, WELL, ETC...) COPIES FOR FILE <br /> LAND USE REPORT APP# -0040 <br /> EHD RECEIVED APP.REFERRAL: Q_ ..1 I "00 COMPLETE & SUBMIT BY DATE <br /> ATE <br /> ATTN: �( rS4e--,( <br /> SITE ADDRESS: "1 E " <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 papulation density, location of house, wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> Zj e <br /> 01 t4- <br /> i <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> i <br /> Supervisor/Lead Senior Comments: <br /> [� . <br /> ® ' 0 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> €'��,"��Praa read re ort & �r'.�a�;:'s Correct LAND CISE#9 <br /> �� � �`�`�� �s'�°�� .���Correct GY1ND,iTION(S}�'�"'' � '� Logged x►I LANI� USE BOOK7 � <br /> EH 06 06 Rev 1199 <br /> r�,r-a_ e z •e adar:,Ai*�>- - .€r,au¢r?�.EfK srr.=: ;<:E�r <br />