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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# LA--(DQ—a13 e-100 <br /> 7 <br /> EHD RECEIVED APP.REFERRAL: i/" COMPLETE & SUBMIT BY�,4 6MP '4 <br /> DATE DATE <br /> ATTN: ?yr_[1Gt_- ��.�.h r I's l <br /> SITE ADDRESS: --- oZ 1 a a a /t Je 2 d 7—v-G c. j <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 /> D VZ <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> EH 06 06 Rev 1199 � �m Co F CONDTTI01V�5')_P�F? Lngg I:.4ND C SEBOQK� <br />