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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP#P/,-r--) ;a - /0cf�64) Ac h os <br /> EHD RECEIVED APP.REFERRAL: 10/ COMPLETE & SUBMIT BY--Z y/ /7/0-5 <br /> DAT "DATE <br /> ATTN: CAL- <br /> ' C <br /> SITE ADDRESS: o � ,�c�S•?►>� �U�-'� f <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 /> I recommend: Approval Denial Continuance Inspector's Signature <br /> fci<frxir*x nit it fexxx*fr it fe fc fexfr�c frxfr fr fc icxxxic f��cxfc frxfr ic><fe fr irxxxx�F frxxxxxr.xfxxfrxfexxz xxx x�c fr fc fexfr*fc is fe fex fc xfc is fr fe fe fe <br /> Supervisor/Lead S, nior Comments: , <br /> z <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 />