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NOTE: PULL ALI, PERMS (SEPTIC, WELL, ETC...) IV...,XE COPIES FOR FILE <br /> I LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: S "I 0 COMPLETE & SUBMIT BY <br /> DATE l DATE <br /> ATTN: �I i m V ald '60cf/1 <br /> SITE ADDRESS: 1 ,�J tj�n /E-, /- cjLp &d . <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: S s c 1�Q G ✓� <br /> T T <br /> / a <br /> 14 <br /> r <br /> 1 <br /> 22r <br /> (f) 11/oSodr S7 � D n . <br /> SUPERVISOR/LEAD SENIOR APPROVAL: — <br /> �, I.S:01 <br /> F: Oa OA II CHECK OFF LIST.• _Proofread report. Correct LAND USE#? <br /> _Correct CONDITION(S)? Logged in LAND USE BOOK? <br /> EH 06 06 Rev 1/99G ; i0 � ' O <br />