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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAN COPIES FOR FILE <br /> LAND USE REPORT APP# yY1 S 00- <br /> EHD RECEIVED APP.REFERRAL: b - / 3 -013 COMPLETE & SUBMIT BY ? - 3 -OQ <br /> DATE ✓� DATE <br /> SITE ADDRESS: U j j' _ /2 �/ l_�, <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 /> 2, <br /> 641I recommend: Approval Denial Continuance Inspector's Signature^ vt/w <br /> nE�'etc*i"c�c�c�Exkicx�Ficicieic�'c�c�c�cic�F�cic�Ex*ic�c�'c�'cic�cx�c*3cic�c*�cx9c��c�F�F�cie3rix�Ficicicx�cx�F*icicX�cic�c�c��c�Fixiric icie�c�c�c�'c�ea'ede$c$c9e r*9e <br /> Supervisor/Lead Senior Comments: <br /> rd <br /> Ul <br /> SUPERVISOR/LEAD SENIOR APPROVAL: 4,... <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 />