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r IV <br /> NO'aE: VULL ALL PERMITS SEPTIC, WELL, ETC...) N.,-.CE COPIES FOR FILE <br /> T,'Ihe <br /> LAND USE REPORT APP# x'15- 9 -a g (< kens; <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY I — V — Q000 <br /> DATE I DATE <br /> ATTN: 'U� r m Q ,'S '►� <br /> SITE ADDRESS: �� 5- <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 /> �.7 � <br /> I recommend: Approval Denial Continuance Inspector's Signatur <br /> �Eic�ric�"c�c�iic�'eieic�c�c3cic*�'c9c�c�F*�c�4�c�c�Ficicic9c�e9ex�'c�'c�Y�F9c�cac�c*�c*9ricdcic�c�Y9c�c�9e�Y*ic�4a'c�cxicicivicx�F*9c*4c�'c�'c�e'ir�c�c�F�Fic�E�� icxic�c�e r9c <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />