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SS <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT ^ I APP# <br /> EHD RECEIVED APP.REFERRAL: �� �"`� COMPLETE & SUBMIT BY__L .D2S- ( <br /> DATE <br /> ATTN: J2 je� � <br /> SITE ADDRESS: 3t LI 1 ': S /C-,,o sJ-e� —VZdT/H� <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: 0 0 Public sewage: dc) <br /> SUMMARY OR COMMENTS: <br /> II'o��ni s�:tTk[StuTY <br /> I recommend: Approval Denial Continuance Inspector's Signature / <br /> Supervisor/Lead Ser Comments: <br /> L� ? a2 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: ' <br /> /f CHECK OFF LIST. —Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev I/99 Iff <br /> Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />