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NOTE: PULL ALL PERM.,,,,) (SEPTIC, WELL, ETC...) PEKE COPIES FOR FILE <br /> LAND USE REPORT APP# S/q - O0 - <br /> EHD RECEIVED APP.REFERRAL: _00 COMPLETE & SUBMIT BY <br /> DATE DATE <br /> SITE ADDRESS: J,e5 -7()5 5 e4 Son du-E -T- a r4 a <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit G.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'D 5/+aw aoe✓�rrv�u EX�57~rvG 5�/'7'rC <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> xx*�E�r zic is icxit ac�kxic�c*�c is is�c�c*�'c irxirx yc�c�c is�'c*xyc*�c icx�c�c*�c�'c**x*scxxxic*xic*zicxx�c ac�'c�'c*ir i��c�c�F icx�cxi��c it it icx:�xic:i ixX is is <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: �XNf\ <br /> OA II CHECK OFF LIST: Proofread report? --�Correct LAND USE#? <br /> EFI 06 06 Rev 1199 __L_ Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />