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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> r LAND USE REPORT APP# — <br /> EHD RECEIVED APP.REFERRAL: o <br /> ac COMPLETE & SUBMIT BY��d10 _ a 7 <br /> 6AVE DATE <br /> ATTN: _�pAC <br /> S <br /> SITE ADDRESS: /5 g S S _ GE' _- � L i iY <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 /> f <br /> Public water: �/� _ Public sewage: <br /> SUMMARY OR COMMENTS: <br /> r � <br /> I recommend: Approval Denial Continuance Inspector's Signature _,- <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> k <br /> +,�,n> ��'._-� <br /> d)A II CHECICIST Proofread rep Correct CA7Vb USE# <br />` E y 06 06 Rev 1/99 � � Correct CONDITIQTY(.4 :� c°r Loggers rn'LA�YI!USE BOOK?3 , <br /> �',.� tr` <br />