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p <br /> �r wNOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# SLA-01-5 <br /> EHD RECEIVED APP.REFERRAL: -� COMPLETE & SUBMIT BY �Q ~ <br /> 3 C' -.t <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: 119780 E. Oakwood Rd., <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.... 1_ <br /> Public water: PMS►' C J pa Public sewage: <br /> SUMMARY OR COMMENTS: <br /> At.,l <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> � ' �c�k�E�aE3cic�r�4�t�c�e*irir�r�F*�r�e�t4t�k�ciricic�k�c3c�kFe9e�e�ex�c�k�r�F�Fak�deie�e�cxde�irir�rvkek*7e�r9e*9s 9t 9c�c��cnE�c*3c�ric�'els'c�citdcaEdc�k�c�4ic9eirieicit�ki� <br /> Supervisor/Lead Senior Comments: <br /> o <br /> Od <br /> k <br /> i <br /> r <br /> SUPERVISORILEAD SENIOR APPROVAL: , <br /> OA II CHEG}I�QFF LIST M fr SPraofread report? "Gorrert LAND USE <br /> EH 06 06 Rev 1199 Correct CDdVDITION(S)9 Logged in LAND USE BOOK? <br /> .;i _':�}.'t? <br />