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�L <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) 1V A COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: IDLIV COMPLETE & SUBMIT BY 7— <br /> DA DATE <br /> ATTN: P 1�F 6Sly,� <br /> SITE ADDRESS: :z 9 j c7 ,5 L ; ._ e <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: 4�� <br /> SUMMARY OR COMMENTS: <br /> Cs n <br /> I recommend: Approval—Z Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOWLEAD SENIOR APPROVAL: <br /> •\ OA H CHECK OFF LIST: Proofread repo ? _Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />