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1 <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC—) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP#' 77 ' <br /> —Z-14 - ?'7- _ :�� <br /> r. <br /> EHD RECEIVED APP.REFERRAL. l k 'oZ COMPLETE & SUBMIT BY — 3 0-99' <br /> DATE ' DATE <br /> ATTN• m tI Gi n e r1en <br /> SITE ADDRESS: 3I �. ,5�, �? /c-J, le7Z dj f c <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—Z Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> Q <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK.OFF��LIS.T.� Pronjrprrd report? • - Correct°LAND USE ff.? <br /> EH 06 06 Rev 1199trorreCt CQNDITIDN(S)9.wLogged ire'I:AND USE BOOK?_ '_ <br />