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re <br /> NOTE: PULL ALL PERM P-S (SEPTIC, WELL, ETC...) Ma,�E COPIES FOR FILE <br /> LAND USE REPORT APP#_ Ms —n ( -3L <br /> EHD RECEIVED APP.REFERRAL:�() �` C)- I COMPLETE & SUBMIT BY — <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: S �� • �r�` <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 />. a <br /> / �. Gt/LC o.r Ugh /fi 41 <br /> I r commend: Approval Denial Continuance Inspector's Signature <br /> Sdpervisor/Lead Senior Comments: - <br /> SiLlna <br /> cd <br /> r � � 3 '� © • a <br /> 1P 0 <br /> 01-7 <br /> 4V OV <br /> SUPERVI OR/LEAD SE IOR APPROVAL: <br /> i :OA II CHECK 0�14'F'' iS a Praofr`e d re 'Orta,W,11-ft"."Correct 41VD USE, <br /> #? <br /> `� t Correct `f}ND�7I(711�(S)9 �ngged InD USE BUOY' f <br /> EH 06 06 Rey 1199 b x € €3 <br /> €,a.a.r€,,,,< �3', ?,.�$�?z'€§`2„d <br />