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T111 <br /> 1!IOTE: PULL ALL PERM.I'S (SEPTIC, WELL, ETC...) b_AKE COPIES FOR FILE <br /> LAND USE REPORT �y APP#� X �c�- <br /> EHD RECEIVED APP.REFERRAL:IU^.�����—I COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: )SOI L-ooma <br /> SITE ADDRESS: ) 3q 0 5 N , mrctCt i& /'Q(, 11/o M� 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: -Wwww Public sewage: <br /> SUMMARY OR COMMENTS: <br /> � U 2 <br /> -0 <br /> 77 2- <br /> 1 <br /> I recommend: Approval Denial Continuance Inspector's Signature u-� <br /> Supervisor/Lead Senior Comments: <br /> "r12 D 1 <br /> �2 - 62 <br /> A <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: _Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1199 11 ��orrect CONDITION(S)? ,,,,Logged in LAND USE BOOK? <br />