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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MXKE COPIES FOR FILE <br /> LAND USE REPORT APP# ( j - 9 7 - <br /> EHD RECEIVED APP.REFERRAL:-12 <br /> jlqlqq COMPLETE & SUBMIT BY / o�. - a 9 -9 9 <br /> DAT DATE <br /> ATTN: M ch U e Z h�,(" r,-)c k <br /> SITE ADDRESS: l SZ n q 6 S K-el (o 2 d.1 <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 /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFf LIST. Proofread report? C=- Correct LAND USE#? <br /> EH 06 06 Rev Imv ,,Correct CONDITION(S)? Logged in LAND USE BOOR? <br />