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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC-) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# g W <br /> EHU RECEIVED APP.REFERRAL: ?-O—q0( COMPLETE & SUBMIT BY <br /> DATE BATE <br /> ATTN: _ ; V�a 6 )men <br /> SITE ADDRESS: ey33 L61 . a n d t`0 4P Rd <br /> In completing the Land Use investigation. draw ail 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: "VA <br /> SUMMARY OR COMMENTS: <br /> i&2�--- <br /> I recommend: Approvai_/-""Denial Continuance Inspector's Signature <br /> �R <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA.II CHECK OFF LIST:: Proofread report? Correct LAND'USE — <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)9" Logged in LAND USE BOOK <br />