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t <br /> NOTE: PULL ALL PERM S (SEPTIC, WELL, ETC...) N KE COPIES FOR FILE <br /> LAND USE REPORT APP# M5 - 9 Q/ - �6 <br /> EHD RECEIVED APP.REFERRAL: I "I COMPLETE & SUBMIT BY 710 0 <br /> DATE ATE <br /> ATTN: a ��n rM •S <br /> SITE ADDRESS: jqj6q S • d <br /> In completing the Land Use investigation, draw a 1 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: /V#- Public sewage: <br /> A199- <br /> SUMMARY OR COMMENTS: <br /> Q <br /> 17 <br /> I recommend: Approval Denial Continuance Inspector's Signature r <br /> �edc+rixF�cF*�c�c9eF2'cx�c*�e�c�c�cicF�ric9r*��cieicic�rxixicir*xic�c�c*�e*4*k9eic�c�c�icicicoF*Xic�cicY*�c'c�c�cFF�c�'eF�c�e9c9cdc"c 9rYx3c9civixic <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />