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J 111M <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC-) MAKE COPIES FOR FIILE <br /> APP# <br /> LAND USE REPORT <br /> EHD RECEIVED.APP.REFERRAL:? IO COMPLETE & SUBMIT BY /o71D- 3 <br /> /UDATE <br /> ATTN: V— <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 density, location of house, wind direction, etc.... ` <br /> Public water: /L-�) Public sewage: <br /> SUMMARY OR COMMENTS: <br /> /C F� <br /> ZZ -c <br /> e— <br /> i <br /> I recommend: Approval Denial Continuance Inspector's Signature ' <br /> Supervisor/Lead Senior Comments: <br /> 11 1010, <br /> v' <br /> N G G �yc-I.,w a� �a�-ccl hyo <br /> 2.2 :Q3 <br /> > �! A 12 <br /> 40— t� <br /> � , dS a <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: _Proofread report? Correct LAND USE#? <br /> Correct CONDITION(S)? _Logged in LAND USE BOOK? <br /> El 106 06 Iicv 1199 <br />