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W <br /> NOTE: PULL ALL PERMrrS (SEPTIC, WELL, ETC...) NtAKE COPIES FOR FILE <br /> LAND USE REPORT M APP# J14 -oo - <br /> UW /a <br /> EHD RECEIVED APP.REFERRAL: ( -1/- COMPLETE & SUBMIT BY -o -00 <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: / W 5 o <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: Z--- Public sewage: <br /> SUMMARY OR COMMENTS: <br /> U16 2 <br /> T�2Zr 0 1 <br /> ll/-) 2 - z�l2. <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervi <br /> rsor/Lead Senior Comments: <br /> FZW <br /> 162 ` - <br /> 1 <br /> A� \ <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? °_Logged in LAND USE BOOK? <br />