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'NOTE: PULL ALL PERMI'T'S (SEPTIC, WELL, ETC...) NtAKE COPIES FOR FILE <br /> `LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: <br /> 1 )--a 8-99 COMPLETE & SUBMIT BY 1 - 9 - j 00 C O <br /> DATE DATE <br /> ATTN• kla r wor"O <br /> SITEADDRESS: X520 ss Stag 10-vk- 22 /- ilckd <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: N A" Public sewage: <br /> SUMMARY OR COMMENTS: <br /> 691A o LA <br /> o� <br /> 2 01 <br /> 2 . 0`L nA <br /> 05 ff <br /> �52 . d `1 <br /> I recommend: Approval Denial Continuance Inspector's Signature 'L <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK O F LIST. V Proofread report? _Correct LAND USE#? <br /> EH 0606 Rev I/99 <br /> y Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />