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/NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHn RECEIVED APP.REFERRAL: / rlq—00 COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: f/ lWa G�7 <br /> SITE ADDRESS: /G ,2 .�2-U 9f ALI, . <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 /> -C-VI <br /> I recommend: Approval Denial Continuance Inspector's Signatur <br /> Supervispr[Lead Senior Comments: <br /> 012 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> DA, I Ch[EG°K O F-LISTraofread reports Correct L,4ND USE77. <br /> #9 <br /> p e Correct G©NDITION(S)P ' '` Logged rn LAND USER <br /> EH 06 06 Rev 1199 <br />