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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT J APP# Awe <br /> EHD RECEIVED APP.REFERRAL. V �/1_ qq COMPLETE & SUBMIT BY a s <br /> as <br /> DATEt/ � �� __ DATE <br /> ATTN: I {,U-ZYY r,, <br /> SITE ADDRESS: ?611/9 `Tr2P _ 12 . . C SC.,a,� <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 /> iTg • o9 <br /> (D 102. 9 <br /> I recommend: Approval V Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST.• V Proofread report _�orreci LAND USE 47 <br /> EH 06 06 Rev 1199 1,_Correct COND177ON(S)P Logged in LAND USE BOOK? <br />