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NOTE: PULL ALL PERM.,_:S (SEPTIC, WELL, ETC...) T\ —..KE COPIES FOR FILE <br /> J��J i� 1 Oyu 1 <br /> LAND USE REPORT APP# S -O/ �- � F 4 �� <br /> EHD RECEIVED APP.REFERRAL: \— ftCjT0?10 <br /> COMPLETE & SUBMIT BY Q/l ?/0 3 <br /> � ATE <br /> ATTN: <br /> SITE ADDRESS: n)lti r 5z4rl <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 /> 7 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> xie it�cxx9c is is r.xic�F is is x�c 9c is irxi��cx�cxr'c�cxicxie icx�cx9c is is�c rc 9cx�c>c�c�c is 7c�c rc 9c�E s�9c Zcxic�c�c�cxic is irxxic icxxx Xxir*ic it 9c is is icxx>:icxic�cx <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> 1 OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br />'� Eli 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />