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JV <br /> NOTE: PULL ALL PERMITS S (SEPTIC, WELL, ETC...) MkKE COPIES FOR FILE <br /> LAND USE REPORT APP# �y0-. 3�' <br /> EHD RECEIVED APP.REFERRAL: :2 -)L5-00 COMPLETE & SUBMIT BY R - q - OZ:) <br /> DATEff DATE <br /> ATTN• I I (\h, (JJ h<CL0 i SC-r <br /> SITE ADDRESS: al :5� I S.. �—+i.m M". (�,n f-A rl T t GiC„� <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 /> 70 NOTE SAY; oDe-P=s wl kl- d4)cN�,:) t�tlrwaoRs IN �kfu.r6 <br /> I�-,k � o 1 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> Q- <br /> , 4S <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 1I CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />