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w <br /> h <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) M7eKE COPIES FOR FILE <br /> LAND USE REPORT APP# C -Rg -r I <Pre6v�o/%c <br /> EHD RECEIVED APP.REFERRAL: /� '7 �� COMPLETE & SUBMIT BY /T �� <br /> DATE DATE <br /> ATTN: ) rl l2 !l Y YYI e lis- <br /> SITE ADDRESS: of F' Fre,IcL, �idiW <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 <br /> � ndensity, location of house, wind direction, etc.... <br /> Public water: //V Public sewage: <br /> SUMMARY OR COMMENTS: <br /> AMW1407 <br /> ,ds <br /> 3 //103 & .«> AVCr . <br /> ;I E `� o Tor �' r ! I� <br /> ac) <br /> 02. 1D c5 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST., _Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rev 1199 _Correct CONDITION(S)? Logged in LAND USE BOOK? <br />