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0 <br /> NOTE: PULL ALL PERMt rS (SEPTIC, WELL, ETC...) M%KE COPIES FOR FILE <br /> LAND USE REPORT APT# <br /> EHD RECEIVED APP.REFERRAL: 7 _ 60 COMPLETE & SUBMIT By a –d <br /> DATE DATE <br /> ATT <br /> JTN: <br /> SITE ADDRESS: I I C`J f�J l '�, S ✓e e <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 waterY'—�� � -T Public sewage: G/ <br /> SUMMARY OR COMMENTS: <br /> It ez eltd!!2 70- <br /> 44 3 <br /> 19 <br /> r Zi <br /> 45 <br /> y- <br /> I recommend: Approval enial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> iS <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? _Correct LAND USE t1? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />