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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL. 3` COMPLETE & SUBMIT BY J '2l-q9 <br /> DATE DATE <br /> ATTN: �.1� � <br /> SITE ADDRESS: JOS E . _S4- jC,�- 1 .-20 , <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 /> 1--2— <br /> C_.11Y�-,Ll�LC1YL/� <br /> AAJ <br /> I recommend: Approval Denial Continuance Inspector's Signature t <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA If CHECKOFF LIST. Proofread report? Correct LAND USE#T' <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />