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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP#�S- 99 iy <br /> EHD RECEIVED APP.REFERRAL: 9 -10— COMPLETE & SUBMIT BY _ / -/ <br /> DATE DATE <br /> ATTN: .J e F rid Ae,t' <br /> SITE ADDRESS: / lO/ 9 t/--. PP / car /��� /�C ���n <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 /> � L 6 ✓ <br /> sA72 L. <br /> 113 3/ <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> D Supervisor/LeaSenior Comments: <br /> - 3 <br /> N <br /> S .. o <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA !!CHECK'O$/F LIST: _Proofread ��Correct L4ND USE#? <br /> repo ? <br /> EH 06 06 Rev iinv Correct CONDITION(S)? Logged in LAND USE BOOK? <br />