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NOTE: PULL ALL PERiMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> Ti <br /> LAND USE REPORT APP# 05— �5-0.5 ex-x ",Do <br /> EHD RECEIVED.APP.REFERRAL: 5 COMPLETE & SUBMIT BY (y — /S- 9 7 <br /> DATE DATE <br /> ATTN: C� <br /> SITE ADDRESS: .11) ll? Z-.;" t: <br /> r <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 e <br /> e Ogg <br /> A=n Ale. la y y-A <br /> Oct 4 <br /> I recommend: Approval V Denial Continuance Inspector's Signature") r..' <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: �^ <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> Ell 06 06 Rev 1/99 I Correct CONDITION(S)? Logned in LAND USE BOOK? <br />