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NOTE: PULL ALL PERM'I'TS (SEPTIC, WELL, ETC...) N,.AKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: 6 —S COMPLETE & SUBMIT BY <br /> DATE fL/9f <br /> DATE <br /> ATTN: Vl/m �✓ ��l(C6l�CL <br /> SITE ADDRESS: <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 /> 27Y ' Rose It' neva OLAl Ar vr-M e C 7C-CA <br /> /1/ J ✓ a-P a-J.)e S 7-A a f- Ar �a.,�v s Y' � <br /> ec 4 6-� <br /> dr <br /> I l I <br /> a <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> [OA 77 CHECK OFF LIST., Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />