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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> w <br /> LAND USE REPORT APP# <br /> ek—, <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY dt7 <br /> DATE DATE <br /> ATTN: I <br /> SITE ADDRESS: 1v .P4' <br /> 1 <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: Z�At -<4 Page: <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approvaliz Denial Continuance 1 Inspector's Signature401-1, <br /> Am <br /> Supervisor/Lead Senior Comments: <br /> � 4 <br /> s -Vx <br /> A <br /> W <br /> let, 41 <br /> v V <br /> Ln <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> El <br /> orrecUSECorrect CONI)ILANDUSEEH 06 06 Rev U99 <br />