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life <br /> K, <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELJ,, ETC-) MAKE COPIES FOR FILE <br /> i <br /> .i <br /> LAND USE REPORT APP# C-�+ 0- _ <br /> EHD RECEIVED APP.REFERRAL, ��` ��J COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN.- <br /> SITE ADDRESS: .lq go 5In completing the Land Use investigation,draw all Public Health factors on the exhibit (i.e.: sewage disposal, <br /> water supplies, etc_..)'1 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 /> w <br /> SUMMARY OR CO.MMENTS: <br /> i) <br /> i! <br /> it <br /> it <br /> �f <br /> i� <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> pP p g <br /> jf <br /> Supervisor/Lead Senior Comments: <br /> I� <br /> i <br /> it <br /> ij <br /> ii <br /> i <br /> ' N <br /> i! <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> iM <br /> i! <br /> SOA+TI C/ K OFFLST 'Proofread report? Correct LAND ilSE# ° <br /> EH 06 06 Rev 1/99 E <br /> , ; E Correct CONDITIQN(SJ�� aLogged In LAND i/SE BQOK? <br /> it y-�'.'s-e'Ta 'P,,E.:.�-, a?'^_`'s=c. u,.:as :-.2,.. �.«� .r,5"k„—7,77- ..4.77, <br />