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R3 <br /> NOTE: PULL ALL PERMTfS (SEPTIC, WELL, ETC...) Nr,-�KE COPIES FOR FILE <br /> LAND USE REPORT �/ p APP# <br /> EHD RECEIVED APP.REFERRAoC L: � O COMPLETE & SUBMIT BY 9/ 1 <br /> DAZE — ATE�— <br /> ATTN: <br /> SITE ADDRESS: �2 l �1 LAAJ 440w Cvy E oD 'A C' '"`_ <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 /> r <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> 1[�M-jj CHECK OFF LLVT. Proofread report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE BOOK? <br /> I'It 06 06 Rev 1/99 <br /> r <br />