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s <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) tvIAKE COPIES FOR FILE <br /> LAND USE REPORT APPH {LA-":91` <br /> $ &-A rp. <br /> EHD RECEIVED APP.REFERRAL: 5 I COMPLETE & SUBMIT BY a's f+ f $_ - "-01 <br /> D E/ <br /> DATE <br /> ATTN: !—e a n n f'_ MAP C _ <br /> SITE ADDRESS: x4071 E.Hayne -Ln <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit (i.e.: sewage disposal, <br /> water supplies, etc...). Where necessary, on an attached piece of plain paper, draw completed map of area <br /> showing population density, location of house, wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> iEF�t�ek�r�r�r�r�icF9t�e�rdr�r9e�k�e�r�ck�!c$e9t�Fk�rvk�e�c�r�eoE�t3e�e3e9e9e�e9r�e�e�ez�k�F�c3c�t�e*ieelr�c�rde�FvF�� F�9ririk�r'eelr�c�r 3c dcF*xFrxx'it c>rz <br /> Supervisor/Lead Senior Comments: <br /> l-� z . a � l <br /> 4- <br /> _77- <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK GFFFLIST• ..s Praofsead repnrt7�;M:$ Correei'LAND,USE#' <br /> EH o6 ob Rev i�9a ,y • Correct CONDITION(SJ < " .Lugged in LAND USE BOOK? <br />