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X , <br /> 'NOTE: PULL ALL PERM t,S {SEPTIC, WELL, ETC...) �AKE COPIES FOR FILE <br /> 13 <br /> LAND USE REPORT APP#�}M <br /> EHD RECEIVED APP.REFERRAL: -3 -0-0-01 COMPLETE & SUBMIT BY {'( - ,3-0 <br /> DATE DATE <br /> ATTN: - e.o►n n e- W J d(e.�L <br /> SITE ADDRESS: I i 15 j L ; 4, A? ad , <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: -f'" Public sewage: <br /> SUMMARY OR COMMENTS: <br /> 'IT <br /> r <br /> 1 e, y- ideAg <br /> I recommend: Approval Denial Continuance Inspector's Signature !''° 2 <br /> i�9r*�r*9r�ex9r�e�r *E6=,A�ic <br /> Supervisor/Lead Senior Comments: <br /> 0 � - <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> E� :Prao read re ort? Co'rrecl LAND IISE#9 <br /> OA II CHECK OFF LIST f P �, <br /> Ex 06 06 Rev 1r99 :, .Correct CDNDITION(S) �Logged lir LAND USE'BOOK? <br />