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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> i <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: `� COMPLETE & SUBMIT BY <br /> DA DAT <br /> ATTN: wo <br /> SITE ADDRESS: o2 y�Q y, Ci�'Gi/� �� `5�lac _ <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 /> E 4 .9 <br /> Army� IDS <br /> ! T <br /> 4 <br /> !P <br /> ' b <br /> �.\. <br /> a ` s <br /> I recommend: Approval Denial Continuance pecto 's Si <br /> I gnature <br /> Supervisor/Lead Senior Comments: <br /> F <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> -',: .,�, ., n 1S,'";e F wa.E- ,tr ,w x "•,'moi*Zpk- ; w;. <br /> SOA II Cl3ECK UFFLIST 4;4' <br /> pit <br /> report777- <br /> 9 � =Correct LAND SSE# p"; <br /> Correct CDNDITIDN(S)?�� � Logged rri Lr4ND�TISEBOOK?y <br /> EH 06 06 Rev 1/99 <br />