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NO'T'E: PULL ALL PERN1'fTS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> T;�r+e? <br /> LAND USE REPORT APP# 5/q - q q -7/ 2Xi Zr,0 3 <br /> EHD RECEIVED APP.REFERRAL: Y— COMPLETE & SUBMIT BY 5 — 8 — f/ <br /> DATE DATE <br /> ATTN: L <br /> SITE ADDRESS: 2S-355 S.f f E , = if d CLQ <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 /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST.• Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />