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NOTE: PULL ALL PERNftTS (SEPTIC, WELL, ETC...) NTAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> 11 /� <br /> EHD RECEIVED APP.REFERRAL: 1 �-,�p—q9 COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN• c)ryrn a <br /> SITE ADDRESS: �j 3$ b' � , _a- f�J, �I�,v► <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: 4�A-- Public sewage: <br /> SUM`/MARY OR COMMENTS: <br /> f'f <br /> D <br /> , 0�/ <br /> 1-57 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECKOFF LIST: aofread report? -LCorrect LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />