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NOTE: PULL ALL PERMIKS (SEPTIC, WELL, ETC...) 1rYAKE COPIES FOR FILE <br /> LAND USE REPORT APP# 5 4 - cl c, — --;5Y, <br /> EHD RECEIVED APP.REFERRAL:3",1-7 —O' COMPLETE & SUBMIT BY q— / 7 -0 ( <br /> DATE DATE <br /> ATTN: j Q�vlo h Q <br /> SITE ADDRESS: 1 -7 '�j S f 2 / HVQ L� R ;P o/1 <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: t.d'' Public sewage: <br /> SUMMARY OR COMMENTS: <br /> OF <br /> I recommend: Approval Denial Continuance Inspector's Signator <br /> *9e*ir,Ir�E*�F rr is is F ixx iir ix*ic�k it�c r'r>Fic*ixic�c icx�c�rx rc is icx irxxic;Fxic�cxic iczicx ixxixic�cx is is�c icxirx icx�i 'rxirx�c etc 4c 4e�r��rx�cxxirz <br /> Supervisor/Lead Senior Comments: <br /> oy <br /> ccs <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EF1 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />