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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...} MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: –Y- fq-Y-fCOMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN• <br /> SITE ADDRESS: / Al/C-010 led-' <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 /> D - <br /> /=a`7 <br /> ll:o� <br /> 11:03 <br /> ll!a 9 <br /> ldz:oz' <br /> IOZ • 0y <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> .F****de*�e9e*****'cir*�ritIeYt***iric*ie**:irk9r*****9e*ie�e*Fhtr*�Ir9eie****ieu�r�e*Ir�e>e***:E**afe�rir*k*�t�c****ir**irieir*xx* <br /> Supervisor/Lead Senior Comments: <br /> —D <br /> d � - <br /> s- Tz: <br /> J <br /> 2f� <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK.OFF UST: roafread report? C—Correct LAND USE#? <br /> EH 06 06 Rev 1/99 ::�GCorrect CONDITION(S)?.' L in L.lND USF BOOK? <br />