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K� <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) N1wKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL:/ Q-,?1-00 COMPLETE & SUBMIT BY a - a 9-00 <br /> DATE / DATE <br /> ! A <br /> ATTN: ielr( or //// <br /> SITEADDRESS: QS/ /its /o Aee- 1&, �,erlcli ( dye;> <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 Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Cgmments: <br /> ✓rte _? /�' ^- f�� � vtru C,,I-yFl.a��" <br /> � V <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. _Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rev 1/99 <br /> Correct CONDITION(S)? _Logged is LAND USE BOOK? <br />