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NOTE: PULL ALL PERMITS {SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> 5 + <br /> Y LAND USE REPORT APP# L n- q 1? <br /> pp [/ <br /> EHD RECEIVED APP.REFERRAL; d -13 -9�t_ COMPLETE & SUBMIT BY '* 51 Y� �g <br /> DATE DATE <br /> ATTN• m o Aa a n <br /> SITE ADDRESS: s���lv ��y� /—&Ae S rkC m <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: MAI Public sewage: _,I <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> 'c9t�s****** Fic9cakacic*de**de:kde�'r�Y9t�klctlyde*ie ieY** Irir�rvieir***edt�c�Ir�c'cie*ir*ic$dcir*****ztc********* x�c9e�t*'�cir4titx��*�t�kY <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECKOFF LIST: Proofread report 7 Correct LAND USE/ ` <br /> EH 06 06 Rev €199 � Correct CONDITIDN(S).:, ] ogged ur LAND USE BOOK? <br />