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i <br /> NOTE: PULL ALL PERMI3.e (SEPTIC WELL, ETC...) Mr,.-dE COPIES FOR FILE <br /> LAND USE REPORT APP# , 54 <br /> EHD RECEIVED APP.REFERRAL:DA/- /6 / COMPLETE & SUBMIT BY <br /> DATE <br /> ATTN: _�.p A n r(n, MLp 11PIr <br /> SITE ADDRESS: �p�,-J(� CL <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 populationdensity ocation of house, wind direction, etc.... <br /> Public water: Public sewage: S �l <br /> SUMMARY OR COMMENTS: �— <br /> I 0 ?� <br /> o � o <br /> I recommend: Approval-Z Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> © y <br /> l <br /> r <br /> • Q <br /> O. <br /> 01 <br /> SUPERVISOR/LEAD 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 />