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6jm4kff <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) 1VI"AKE COPIES FOR FILE <br /> LAND USE REPORT APP9�zr4 <br /> EHD RECEIVED APP.RFFERRAL: U COMPLETE & SUBMIT BY <br /> DA ATE <br /> ATTN: U a <br /> SITE ADDRESS: 2, 1 r.2 ro` Ol a� <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 /> 110 <br /> 1 4 AS <br /> �4 dam•+ <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �k*nF�c9c�rdr$t�riv$c9tvFie�r3cdcaF�e�r�ck�c*�F$r�caF�cAedeicxdc�eSexdck$c9c�cac*dc�k�edr9cdc�lc$cic*ic��kxicvFdsTe�en4iris�r�e$e9c�Edt�F '$ckaF$r rhe*iritirxdc�ric <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> LAND USE LOG r <br /> OA TI CHECK OFFLIST _ Proofread report? 3 Correct LAND USE# T <br /> Corect ClINDITIOIV(S) Logged rh LANDUSE BOOK :. <br /> Eli 06 06 Rei ON CALENDAR = �� - " <br />