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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) rv.,.KE COPIES FOR FILE <br /> ' LAND USE REPORT APP# fi c-,00 -4j <br /> EHD RECEIVED APP.REFERRAL: / -Q 'CEJ COMPLETE & SUBMIT BY — 10 —yy <br /> DATE DATE <br /> ATTN• cA �� l►Urn -, <br /> l <br /> SITE ADDRESS: 6-3( 51-,-,k A'dIA Q , <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: A Public sewage: <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �1c�r�cic�c*�i9c*�r�es2��cie�e�'c�c�e�e�k�k�c�c�'c�'cie9c�c�c�Fix�x�'etc*i+cic�c�r�'c��ede9c�c�e�F4e**�c�c�F�c�F�'cieieicxie9c��F�4�Y*�e�Fx�ercic�cie�k*ieicxx�cicic�cic�cx <br /> Supervisor/Lead Senior Comments: <br /> I0 : 4 V <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OfF LIST. Proofread report?? Correct LAND USE#7 <br /> EH 06 06 Rev 1/99 �° Correct CONDITION( ? V Logged in LAND USE BOOK? <br />