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NOTE: PULL ALL PER, 'TS (SEPTIC, WELL, ETC...) BIKE COPIES FOR FILE <br /> LAND USE REPORT APP# s/- -0 i - a( (-r6-) <br /> EHD RECEIVED APP.REFERRAL: h 7 C)�-- COMPLETE & SUBMIT BY I a - 3 C) Z <br /> DA DATE <br /> ATTN: no n d ! .,o I I le& �/A <br /> SITE ADDRESS: a b cf :2 -2 S . eVIM 2,(f ,fd _ . Tro L. <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 L(7 <br /> Supervisor/Lead Senior Comments: <br /> A <br /> SUPERVISORILEAD SENIOR APPROVAL: f <br /> T <br /> OA /I CHECK <br /> 'LIST. Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rev "9 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />