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NOTE: PULL ALL PERMIYS (SEPTIC, WELL, ETC...) Mat`KE COPIES FOR FILE <br /> LAND USE REPORT APP#-,5r (-Lam i V- Q-o� <br /> EHD RECEIVED APP.REFERRAL: 7 COMPLETE & SUBMIT BY , - a -V <br /> DATE DATE <br /> ATTN• �l ✓16 J1je,L rrn v 'c 1 e r <br /> SITE ADDRESS: <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 n� it�de/nns_ity, location of house,wind direction, etc.... /V A <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> 6". 0Y <br /> Q p7 <br /> 1 b3 <br /> s- 22 <br /> Z , <br /> I recommend: Approval Denial Continuance Inspector's Signatur <br /> Supervisor/Lead Senior Comments: <br /> 0 <br /> LAI <br /> SUPER A S A ROVAL: <br /> OA I/CHECK OFF LIST: Proofread report? / Correct LAND USE#? <br /> EH 06 06 Rev 1/99 _.Correct CONDITION(S)? Logged in LAND USE BOOK? <br />