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Afc <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) ITTAKE CO IES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: ) -,23-00 COMPLETE & SUBMIT BY <br /> DATE l DATE <br /> ATTN: D1 r' L ✓► c4 <br /> SITE ADDRESS: 00 e _� 102 y AA)y g=jAzp i o <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 /> /® <br /> k -7 <br /> b C, 74 <br /> AOO <br /> z�. 4 <br /> � �0 �? • <br /> JV <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: , <br /> 4L <br /> r „n, �n <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> Correct CDNDITION(S)? Logged in LAND USE BOOK? <br /> EH 06 06 Rev 1/99 <br />