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..� �-" �•• Wit.. ,Q � <br /> NOTE: PULL ALL' PERMI-A'S (SEPTIC, WELL, ETC...) MHKE COPIES FOR FILE <br /> LAND USE REPORT APP#--�- <br /> �7 �y co-a -ate <br /> EHD RECEIVED APP.REFERRAL: ` pC —00 COMPLETE & SUBMIT BY � <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: <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: ,C/O,v� <br /> SUMMARY OR COMMENTS: <br /> , 6 <br /> f:` 63 <br /> Z2 f 61 <br /> I recommend: Approval Denial Continuance Inspector's Signature Q <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> rre <br /> .IST � � Pta�fredrl report? :Coct LAND llsE'#9 <br /> EH 06 06 Rev 1199 gf Cavriect C4IVDITION[S)? Lagged rn f_AND USE BO(711��„ <br />