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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: 61?Z9q COMPLETE & SUBMIT BY <br /> 15ATE / DATE <br /> ATTN: , j V- t—t- S jV r <br /> SITE ADDRESS: 8,5 A L e P _-r✓ 111L caj <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 /> P--Le- <br /> C� <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA /I CHECK OFF LIST. oofread repo Correct L,4ND USE#? <br /> EH 06 06 Rev I/99Correct CONDITION( )? Logged in"VD USE BOOK? <br />