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~NOTE: PULL ALL PERMI'T`S (SEPTIC, WELL, ETC...) MIAIKE COPIES FOR FILE <br /> LAND USE REPORT APP# S - 9 7S 4�ISej <br /> EHD RECEIVED APP.REFERRAL: <br /> 7_I.2-ce COMPLETE & SUBMIT BY <br /> DATE l DATE <br /> V <br /> ATTN: Oen ijre-eN <br /> SITE ADDRESS: � ,� } .S �LD u —�� �'`� Lod� i <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: llltly <br /> SUMMARY OR COMM TS: <br /> i <br /> / <br /> t <br /> r 5 ra r <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> d <br /> S <br /> i t <br /> SUPERVISORILEAD SENIOR APPROVAL: jj� <br /> 0A 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 />