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NOTE: PULL ALL PERMrtS (SEPTIC, WELL, ETC...) NPAKE COPIES FOR FILE <br /> LAND USE REPORT APP# 1815- ��- 7 -Q �� �Aeag <br /> E.HD RECEIVED APP.REFERRAL: j —ol COMPLETE & SUBMIT BY �2 <br /> DATE / DATE <br /> ATTN: J,M h " 6,2a q <br /> SITE ADDRESS: I q q N -7 6 7-0 �i ����yn�_1�� 4-o cl: <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: '.Em.00-0— Public sewage: <br /> SUMMARY OR COMMENTS: <br /> U-7 01 <br /> I recommend: Approva Denial Continuance Inspector's Signature !1 <br /> Supervisor/Lead Senior Comments: <br /> d� <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST.• Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />