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NOTE: PULL ALL PEIMITS (SEPTIC, WELL, ETC...)"MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> v p�j <br /> EHD RECEIVED APP.REFERRAL: �b r7 / COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: e �/1l r I I_fill <br /> SITE ADDRESS: �), 5 ,4 S , 5c-4„ /14e <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 /> �0'oy <br /> 20:01 <br /> W-, <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST.• Proofread report? Correct LAND USE#? <br /> EFI 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />