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NOTE: PULL ALL PERNITTS (SEPTIC, WELL, ETC...) IWAKE COPIES FOR FILE <br /> LAND USE REPORTAPP# 5 ,4 ::Q 1-09 <br /> EHD RECEIVED APP.REFERRAL: I,,— J4=:d & SUBMIT BY 2 _ ( — 01 <br /> DATE �� DATE 3 <br /> ATTN: � /`o- <br /> SITE ADDRESS: �,!22 mi,;, S '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 /> l� <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> A- <br /> OA II CHECK OFF LIST: —Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rev 1/99 <br /> Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />