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(�uli old fi /c Jy <br /> NOTE: PULL ALL PERMt-rS (SEPTIC, WELL, ETC...) Nr,,iiKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: Lj I 710 COMPLETE & SUBMIT BY <br /> DXff DATE <br /> ATTN: Wjj e-1 le,� <br /> SITE ADDRESS: S <br /> In completing the Land Use investigation, draw all Public Health factors on a 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 /> it-O3 <br /> Ir p 5 <br /> 11� � 7 <br /> cyc�� 5/f/1G c LLE Te5Te i, �nQ N 17-R/4 7'e-5 pklc)K 7'0 55unticF tau �C�r i ��,;- <br /> xi <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Le.A Senior Comments: <br /> yy r <br /> .J <br /> o t i. <br /> d � <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 11 CHECK OFF LIST: _Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />