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r b ? <br /> `NOTE: PULL ALL PERMh 5 (SEPTIC, WELL, ETC..,) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> n ,�1 <br /> EHD RECEIVED APP.REFERRAL: `�� COMPLETE & SUBMIT BY� 4SI 'e y(o -- "0 <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: I Q yba 5 c 1 C4 m Glta/1 d ?- <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 /> zq <br /> I recommend: Approval Denial Continuance Inspector's Signatu <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: ,+ <br /> :10 <br /> A�.lT�GHEGIf OFEli ob o6 Rev i�99 �� <br />