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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: 6 9 COMPLETE & SUBMIT BY�� <br /> DATE DATE <br /> ATTN• E b L <br /> SITE ADDRESS: a q 5// nl . 5f-, q9 14) . 1,,jha e �c3: /go go <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: A16 "I/ Public sewage: <br /> SUMMARY OR COMMENTS: f <br /> -'i ) .J /LG/r lr� �tgn, <br /> ,r <br /> I recommend: Approval Denial Continuance Inspector's Signature=." , <br /> ie�c�'cic9c�eieicicicx*9c�e�'c�c*�c�c�cie�eie�ex�e9c*�Fieie*icxaiie�Irie*ie ie ie�e�cix*�eir�'eieieeF4e*ieokxieie**ie ie ie*9e4e:F�F�e�e�c�kicx*�E�eieiede�ie.�E�F.�cixieXie <br /> Supervisor/Lead Senior Comments: <br /> GP�1P. r r p� <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> I OA II CHECK OFF LIST: Proofread report? _l Correct LAND USE#? <br /> EH 06 06 Rev 1,99 ✓' Correct CONDITION(S)? Logged in LAND USE BOOK? <br />