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/_.(z <br /> NOTE: PULL ALL PERM'S (SEPTIC, WELL, ETC...) NrAKE COPIES FOR FILE <br /> l Pie- <br /> LAND USE REPORT APP# 1 p//�� —U �5�✓ a���lc" <br /> EHD RECEIVED APP.REFERRA p O COMPLETE & SUBMIT BY �/ <br /> n II DAT <br /> ATTN: Le"Lnile 'r`I]P F1EI <br /> P� <br /> SITE ADDRESS: a d <br /> In completing the Land Use investigation, draw all Public He lth 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 /> O.S- <br /> . Moe, <br /> 1000, <br /> .J M <br /> I recommend: Approval Denial Continuance Inspector's Signatur <br /> x*x• <br /> Supervisor/Lead Senior Comments: <br /> w <br /> 3 <br /> C <br /> a <br /> �r� baa o5' <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA/I CHECK OFFL/ST: _Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rev 1/99 _Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />