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NOTE: PULL ALL PERMITS SEPTIC, WELL, ETC...) TVi E COPIES FOR FILE <br /> LAND USE REPORT APP# A -0 l v a 7 <br /> n � <br /> EMD RECEIVED APP.REFERRAL: U COMPLETE & SUBMIT BY��S�C' <br /> DAT DATE <br /> ATTN: <br /> SITE ADDRESS: Q- SO e /V <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: 3 Public sewage: <br /> SUMMARY OR COMMENTS: <br /> (419 <br /> i <br /> O <br /> I recommend: Approval VIDenial Continuance Inspector's Signaturc;69Ai <br /> Supervisor/Lead Senior Comments: <br /> 9 <br /> if <br /> F <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> I r <br /> !OAII CHECK OFFLI.ST« dProofread report? FGorreet L:4IVDUSE# <br /> PCblrec CDNDITION(Sf? Lo gri.in D USE-BOOKS <br /> EH 06 06 Rev 1199 <br />