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NOTE: PULL ALL PERMnS (SEPTIC, WELL, ETC...) MMKE COPIES FOR FILE <br /> T/m c <br /> LAND USE REPORT APP# 6-x i 6-12&1o1� <br /> EHD RECEIVED APP.REFERRAL: / —UG COMPLETE & SUBMIT BY 2 /— O <br /> DATE DATE <br /> ATTN: �/A n <br /> SITE ADDRESS: t�U � i,.,l 2 d j ,A C, 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: — Public sewage: <br /> SUMMARY OR COMMENTS: <br /> -D <br /> �• is .. <br /> —e <br /> I recommend: Approval Denial Continuance Inspector's Signature 4 � oe-...� <br /> *ixicicx9cicie*ie� EFki+r9c*9r*k�cic�rFrFscx*�cic�r9ex*>F�c'ezxx�c�cic�c�t>c9c�ic*4c*k 'cF* 'er9exicicic*irsecixirirrxx*1r4edeicicirxxic�cicrc <br /> Supervisor/Lead Senior Comments: <br /> Aar <br /> 112. <br /> SUPERVISOR/L.EAD SENIOR APPROVAL: <br /> OA H CHECK OFA'LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 ✓ Correct CONDITION(S)? --L-,-Logged in LAND USE BOOK? <br />