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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) N-IrAKE COPIES FOR FILE <br /> LAND USE REPORT APP#�s5A - 9'7 <br /> EHD RECEIVED APP.REFERRAL: U -,21 COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: Ll /1 <br /> SITEADDRESS: 1 Q y q 54Z.& 6 iA- Z120 /h/1-icia <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 /> z <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK O�ff LIST: Proofread reports Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? =Logged in LAND USE BOOK? <br />