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0*T,E: PULL ALL PERIl+ S {SEPTIC, WELL, ETC...) TAKE COPIES FOR FILE <br /> LAND USE REPORT APP# e,4-01 -71 <br /> e)y sfm <br /> EHD RECEIVED APP.REFERRAL: 9 V o COMPLETE & SUBMIT BY 1 pl bI <br /> ! DATE wD E <br /> ATTN: Lez.nn,G Y <br /> SITE ADDRESS: 4x'70 , 0-witlna A'WnGi?i rSSUCIA" <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: 120 Public sewage: /A <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Si r w <br /> Supervisor/Lead Senior Comments: <br /> tat <br /> v <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> �DA 1T GHBCK O]�'F�CST• ��-��-�Proofread report� � �' Correct�lNbUSE�9` " <br /> EH 06 06 Rev 1149 Correct C�NDITl01V(S)TLogged.lnLAND-USE BODK7 <br />