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z6 <br /> NOTE: PULL ALL PERMrtS (SEPTIC, WELL, ETC...) NktKE COPIES FOR FILE <br /> LAND USE REPORT APP# L 00 -L& <br /> r f <br /> EHD RECEIVED APP.REFERRAL: 7 3 --00yQ,/Q 0 COMPLETE & SUBMIT BY J/✓ / 7 — ( 3 v U� <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: oZ g Jc / e--;Lp� <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 /> /V / <br /> Public water: VW Public sewage: <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approvalenial Continuance Inspector's Signature <br /> 9r�1r4c�c�t9r�c$ciicdc�F*'cicF9c�cicdc*fir 9c�r**9c 9c*�F9caFa'c�F9c*9caF9t�k4r9r9r�F�c�c�c�cdc*�c�F�F�F�caY9c�r�'c�caF*�c�c�r*9c 9c*icicsc�cF*dcnF sr F�'e9c�r*9c�c�c <br /> I <br /> Supervisor/Lead Senior Comments: <br /> v <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />