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y <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# yes- 9 62 - / <br /> EHD RECEIVED APP.REFERRAL: q — v —Y9 COMPLETE & SUBMIT BY — -2 G %9 <br /> DATE I DATE <br /> ATTN: ChA a /Jel- 1rL(�1�,-1 <br /> SITE ADDRESS: n-ord)Pr i1Uf Sf/1�'rd <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 /> Jo <br /> I recommend: Approvals Denial Continuance Inspector's Signatureli.� � <br /> Supervisor/Lead Senior Comments: <br /> SLPERVISOR/LEAD SENIOR APPROVAL: AMn <br /> OA 11 CHECKOFF.LIST. LProofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 _Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />