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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MtiKE COPIES FOR FILE <br /> LAND USE REPORT APP# 1 A <br /> EHD RECEIVED APP.REFERRAL: /(-- QQ `00 COMPLETE & SUBMIT BY zq <br /> DATE ! DATE <br /> ATTN: �;,p e�lltlr'P _ t3�f <br /> SITE ADDRESS: T�� .� - Jar Nt Cc 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 /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA I�CH,�CK aFF LIST � � Proofread report? Correct LA1VI)IIS # <br /> E H Ob 06 Rev 1199 Corr eM CONDITION(S)?6,x`9 Logged in LAND USE BL1QK� c <br />