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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) ATAKE COPIES FOR FILE <br /> LAND USE REPORT APP#� 01 <br /> EHD RECEIVED APP.REFERRAL: I 1 COMPLETE & SUBMIT BY — a <br /> DATE DATE <br /> ATTN: (1"(t� W,-"4 0. <br /> SITE ADDRESS: lc,2-0 4c,,)y .a <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 /> **�Fr'r�e�r*4t 9e�r�e*�e�'eeF9e4c4e�r*9e�c�c�e�dcir9ri��c�r*ic�i�ic�c&�R*icir�c�cnE9r*x�E*ir�c�e**�c9c�9c4r�'e�'c�e*9e�e�e9e�car*de 9e ieir*i�ie�rieae�cie�ciric�'eie9cx <br /> Supervisor/Lead Senior Comments: <br /> 0 y <br /> C-- 72a • <br /> SUPERVISOR/LEAD SENIOR APPROVAL: .T.yh qt /1/o•3 �" �' ��O. J <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 />