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-NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> r LAND USE REPORT APP#,_SW - gT-ea <br /> EHD RECEIVED APP.REFERRAL: LQ -C�b�O COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN• X a,- �-u o r►-.o� <br /> SITE ADDRESS: 3 ap 6 61 <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: \/�"5 _ Public sewage: <br /> - <br /> SUMMARY OR COMMENTS: <br /> f0z ` by <br /> � o2 <br /> I <br /> I <br /> I <br /> I recommend: Approval ox Denial Continuance Inspector's Signatu e�#e <br /> Supervisor/Lead Senior Comments: <br /> d 1 <br /> I - qk <br /> I <br /> I <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> I <br /> OA TI CHECK QFF LIST Proafiean!report correct LA <br /> NI)USE#r <br /> EH 06 06 Rev 1199 <br /> G'orreel C4NDITIDN(S)7 Legged in LAND USE BOUKT ,. <br /> -- <br /> yam.. <br />