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1 <br /> NOTE: PULL ALL PERM-rrS (SEPTIC, WELL, ETC...) N1rAKE COPIES FOR FILE <br /> LAND USE REPORT APP# ��"'� <br /> EHD RECEIVED APP.REFERRAL: t G�5 COMPLETE & SUBMIT BY n/L.,L/t/ L� <br /> DAW D TE <br /> ATTN: V U %L <br /> SITE ADDRESS: a 1 -) <j- o-� i,_(` � l r !t �' � fG C+L-fG� <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 /> AQ <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> e <br /> f : d <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST. Proofread report? Correct L4ND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />