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NOTE: PULL ALL PERM.AS (SEPTIC, WELL, ETC...) N__�KE COPIES FOR FILE <br /> LAND USE REPORT APP# GQX-2L leeUtJe6/ <br /> EHDRECEIVEDAPP.REFERRAL: ,S -/.�-cp COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: / , n 01 a <br /> SITE ADDRESS: ami y D n fn-o�- ri ' & led , -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 /> P 21 2 <br /> za vi,Lf A "jor�P,� X I I -t <br /> r <br /> � U <br /> i <br /> I recommend: Approval Denial Continuance Inspector's Signature 01�cl d <br /> I recommend: <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST. Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rev 1/99 11 _Correct CONDITION(S)? Logged in LAND USE BOOK? <br />