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LG- <br /> NOTE: PULL ALL PERM,,.tS (SEPTIC, WELL, ETC...) l E COPIES FOR FILE <br /> LAND USE REPORT APP# 19,4 - b a _ f, 3�, <br /> EHD RECEIVED APP.REFERRAL: -0 COMPLETE & SUBMIT BY 0 3 <br /> DAT <br /> DATE <br /> ATTN: j 6S Gk h es <br /> SITE ADDRESS: -, () 9CCD �_ f a o T ) -kCe;;L <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 /> I recommend: Approval Denial Continuance Inspector's Signature " <br /> ZA <br /> Supervisor/Lead Senior Comments: <br /> a <br /> P <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />