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i `NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# SA- - q41 -714 <br /> EHD RECEIVED APP.REFERRAL. G 0 !DATE COMPLETE & SUBMIT BY AsA P DATE U g q <br /> _ <br /> ATTN: e 1 � <br /> SITE ADDRESS: <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 /> y�/�� <br /> Public water: Public sewage: ' r/ <br /> SUMM RY OR COMMENTS: <br /> H Ll <br /> V1.C <br /> r <br /> roll � <br /> IV <br /> Cn <br /> I <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 11CHECK 90F msr.-: Proafread report?,; Cbrrect'L4ND USE#9 <br /> EH 06 06 Rev u99 t CorrectCOND1770N(S)T'. Logged in L4YVD USE BDOK? <br />