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r/V <br /> NOTE: PULL ALL PERNMS (SEPTIC, WELL, ETC...) RAKE COPIES FOR FILE <br /> LAND USE REPORT ?? / � APP# I t �V <br /> EHD RECEIVED APP.REFERRAL: J -`J -ll(" COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: —rind, <br /> SITE ADDRESS: v w eE7 ��A ��_� 2U <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: l/ocPublic sewage: <br /> SUMMARY OR COMMENTS: <br /> 0-3 <br /> — ALL (r/zsTwe 7 AxY <br /> // A Ott- VAI 2 mak,, l <br /> I recommend: Approval Denial Continuance Inspector's Signature/; a�7 C-�� <br /> Supervisor/Lead Senior Comments: <br /> 3. 16 . 01 wn-s t� <br /> �'✓ �Sol <br /> �\ SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />