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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) NTWKE COPIES FOR FILET <br /> LAND USE REPORT APP# e& `D <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY <br /> D p ) DATE <br /> ATTN: 6�T <br /> SITE ADDRESS: s Ck <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 /> ����,���r��I�.i• ls�/ice/�=�� <br /> /'/-J/11�i �/ Tif��sz;✓F c2�yr�J-�'1� -4�7 /�-Lfi���f R� 4�`�J,Fti t7�.�;�-�.� <br /> ��- <br /> .C/ <br /> I recommend: Approval ✓ Denial Continuance Inspector's Signat <br /> Supervisor/Lead Senior Comments: <br /> W. <br /> C7/t Lt 12. <br /> r &A- <br /> V <br /> R <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rev V99 Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />