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4L <br /> NOTE: PULL ALL PERMd S (SEPTIC, WELL, ETC...) A,.aKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: 5 <br /> a -00 COMPLETE & SUBMIT BY 5 (0 <br /> DATE DATE <br /> ATTN: —rina <br /> SITEADDRESS: /1 )25 ir=449 4 <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: AJA Public sewage: <br /> SUMMARY OR COMMENTS: <br /> o p�� i <br /> C, x ( 03 <br /> � 2Zoi <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> a <br /> C li ' 03 <br /> e2a of <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA H CHECKOFF LIST., _Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rev 1/99 11 1 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />