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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# l.._/-} <br /> EHD RECEIVED.APP.REFERRAL: N 41 ff COMPLETE & SUBMIT BY �„JJ7/ //✓ �// 7/ 9q <br /> D TE DATE / <br /> ATTN• k- A ,` � ilpm <br /> SITEADDRESS: UI/)0 S. Sf-• {e� � Fi—F /Zah e lCd. <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.... t <br /> Public water: Public sewage: (� UL1lQ,t (a POSe/� I U C4-Y, ' —4 <br /> SUMMARY OR COMMENTS: &--t� <br /> 10 O { 1Q, 0 bev--, f2e.0cxv�, ka) <br /> 7a os fel <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Le for Comments: 7 <br /> 11 <br /> � D <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 11 CHECK Ll <br /> LIST. Proofread report? ' Correct LAND USE#? <br /> EH 06 06 Rev 1/99 V Correct CONDLTLON(S)?. Logged in LAND.USE BOOK? - <br />