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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP#__f 22--�f7 <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY 9- 16 —— 294 14JIV <br /> DATE DATE <br /> ATTN: �, i t1Q�- �V <br /> SITE ADDRESS: 1 2Q 4th C Way .51ock4na <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: L/ S <br /> SUMMARY OR C MMENTS: <br /> 0 <br /> ©la - <br /> I recommend: Approval Denial Continuance Inspector's Signa <br /> Supervisor/Lead Senior Comments. <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA.H CHECK OFF LIST.- V Proofread report?, Correct LAND USE#' <br /> EH 06 06 Rev 1/99 ;� LeCorrect CONDITT4N(S):9' Logged'in LAND USE BOOK <br />