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NOTE: PULL ALL PERMi-fS (SEPTIC, WELL, ETC...) M &E COPIES FOR FILE <br /> LAND USE REPORT G APP# Sa -0d - 6J <br /> EHD RECEIVED APP.REFERRAL: l l' I5 -oo COMPLETE & SUBMIT BY I Q -.S-do <br /> DATE1 ,,a�t DATE <br /> ATTN: � � ; /m V aI rn !JU/e h <br /> SITE ADDRESS: ri ecl .d .�; dL-!c r✓ <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 /> Supervisor/Lead Senior Comments: <br /> � . OQ?n, <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA Il CHECK OFF LIST., Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rev 1/99 _Correct CONDITIO.N(S)? Logged in LAND USE BOOK? <br />