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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) 1viAKE COPIES FOR FILE <br /> LAND USE REPORT APP-4 <br /> EHD RECEIVED APP.REFERRAL:�J 7 COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: e -� he—r <br /> SITE ADDRESS: ] 7,3 oo (,'lJ 62 7 6oriG`-' - <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 /> O VZ <br /> I O J U Z - �u r3 c $ct QS <br /> 90;v 1 Put?, 4�✓}T�CZ <br /> 22;©W TM - <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> rrxir it�c�'c 4c rc�c is sc�c�E�e�e it iex�e ie iex*�c 74 ie*�c ie�[�c�r�e it�e is�Fx�c is�'t ie ie iex�F�c�e ie�e tY�c�c�t�e is is 9e 9c ie ixxx�'c:F�e Lexie it�c�e ie ie X�t�c�e�F ie ie ie is irxic is is is�c <br /> Supervisor/Lead Senior Comments: <br /> 6 <br /> Ldq la <br /> b - �2- <br /> �I <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> 11 OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> 1:11 06 06 Rev 1;99 L- Correct CONDITION(S)? Logged in LAND USE BOOK? <br />