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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...)1vIAKE COPIES FOR FILE <br /> ,e L. rs <br /> LAND USE REPORT APP# UP-C) - 3 .s(-k- Pty n <br /> EHD RECEIVED APP.REFERRAL: (-I-s-'t_) / COMPLETE & SUBMIT BY 1�f — 1— <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: SI i 2 E Plr) 6t i ,i C k <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: —o Public sewage: <br /> SUMMARY OR COMMENTS: e <br /> mo �Sfflr/ yUvt 1�/IYC� .�/ Zd�l/ <br /> I recommend: Approval Denial Continuance Inspector's Signature / <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFFLIST. Proofread report? : Correct LAND USEV <br /> EH 06 06 Rev 1199 _Correct CONDITION(S)? Logged in LAND USE BOOK? <br />