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NOTE: PULL ALL PERMIYS (SEPTIC, WELL, ETC...) M�vKE COPIES FOR FILE <br /> LAND USE REPORT APP# _S/'4 63 <br /> EHD RECEIVED APP.REFERRAL: ID—,'30-00 COMPLETE & SUBMIT BY �� - / .S- U 0 <br /> DATE DATE <br /> ATTN• �in�A--l�uMe]S A-T <br /> SITE ADDRESS: I.S 60 S, Jt, &L t aaL <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: <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> oy <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA lI CHECK OFFLIST: _Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1N5 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />