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V J <br /> NOTE:+ PULL ALL PERMITS (SEPTIC, WELL, ETC...) MA`1�E COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> Cf �I-A <br /> EHD RECEIVED APP.REFERRAL: 1 -3002 COMPLETE & SUBMIT BY 9 R.PY-e � Z7� <br /> DAfFE r A <br /> ATTN: 1VI <br /> SITE ADDRESS: CIQ Ll <br /> In completing the Land Use investigation, draw all Public Health factors on e 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 /> .-o " fyz z: z- +C W <br /> 11 � <br /> 6 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA TT CHCIf OFFLTST.' ` F Prvafread report? s Correct LAND USE#? <br /> EH 06 06 Rev 1199 h=" &� „„ ��CO/1��1D11�X7T7ION(Sf 9 °l,Ogged tJt LAND USE BO()K7 „ <br />