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r Nb TE: PULL ALL PERMS (SEPTIC, WELL, ETC...) 11 K" COPIES FOR FILE <br /> LAND USE REPORT APP# ,S� - 9�'-- 7. - �,�sla <br /> EHD RECEIVED APP_REFERRAL: io~!6 COMPLETE & SUBMIT B <br /> DATE <br /> DATE <br /> ATTN: _ 4 t6 <br /> SITE ADDRESS: U `5 <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 /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: _ET <br /> OA II ClfEClfi ClFF LIST 0, Proofread report?�'M Correct LAND USEW. <br /> �� r.,.m. ..:..:>Y.�w ?, k:3i°�;k>t>s °"`?,'•n.':��i.�'?5, �raLO e�lll ._.. : � 9 ` <br /> t Correct CONDITIONS) y gg <br /> LAND [ISE BOOK <br /> EH 06 06 Rev 1149 <br />