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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) M%KE COPIES FOR FILLE <br /> LAND USE REPORT APP# 61750(9 ) <br /> 7 VC5 . <br /> EHD RECEIVED APP.REFERRAL: lalCOMPLETE & SUBMIT 'N��* \ ` �� �3 <br /> DAT DATE <br /> ATTN: 3j2mp.S ✓a I7 &16rq <br /> SITE ADDRESS: /q U 5 CC— , /--n M ��� '- a Z6 iLT2 <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 II CHECK OFF L/ST: Proofread report? ed corp (ISE BOOK? <br /> rect LAND USE#? <br /> Correct CONDITION(S). _Logg <br /> EH 9606 Rev 1/99 <br />