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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...)-MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# G A- 0-3 - 3,fl <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY YZ:�7t <br /> DATE —� DATE <br /> ATTGN�: �1 C,I- j <br /> SITE ADDRESS: "/3 / _. _�J d l/h 6 <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 /> ZA <br /> I recommend: Approval Denial Continuance Inspector's Signatu e <br /> X <br /> 9cx�cx9r is 9e 9c rcx�c*iez>c�c*�Y de de ie isxisx�c is�c icx�F*kxae se�F aY�c icx�e�e�c ak 9e dr k�c�4�r 9e�c�F rc ie is is 4ex*�'c is�'e�e�e a'e de 9e a'c* xxxx <br /> Supervisor/Lead Senior Comments: <br /> r <br /> ,yf <br /> Ay• <br /> i <br /> SUPERVISOR/LE))AD SENIOR APPROVA <br /> l a � t <br /> OA H CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> E 106 06 Rev 1/9 �, ,p ' 01 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />