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NOTE: PULL ALL PERIMTS (SEPTIC, WELL, ETC...)IT AKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL:�� COMPLETE & SUBMIT BY -S� 7 �Gz3 <br /> D EE //99 � ( //� DAT <br /> ATTN: . l ]/l��tiY� (0466 <br /> SITE ADDRESS: �f733.. �P 4a /ja r4l; 1/I <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 /> s <br /> y <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> Q 7 <br /> �• <br /> // : 0 7 <br /> .lie <br /> i:4� <br /> L <br /> ;Z2 ; Oy 1,2 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: t <br /> /tel OA II CHECKOFF LIST: _Proofread report? Correct=USEO6Rev 199�" Correct CONDITIOA'SJ? Logged in LANDr►v -m,tl�1.,� Waa�o <br />