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NOTE? `PULL ALL PERMrr'S (SEPTIC, WELL, ETC...) NrAKE COPIES FOR FILE <br /> LAND USE REPORT APP# L Ex k,. r a„ <br /> ? 8efjoee <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY/'Sap- (I -OL -ol <br /> DATE / DATE <br /> ATTN: -9 6� <br /> SITE ADDRESS: Yl n o _S. Com. ,,e-j- . 915' E . <.?e And. <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 /> SUPERVISOR/LEAD SENIOR APPROVAL: — <br /> OA II CHEC%OFF LIST. _Proofread report?, CorrectLAND US6#? <br /> EH 06 06 Rev 1/99 Correct CONDITIONS)?- Logged In LAND USE BOOR? <br />