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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# (%� P- C19 3 <br /> EHD RECEIVED APP.REFERRAL: 0—k --9CA COMPLETE & SUBMIT BY —,50-q <br /> DATE DATE <br /> ATTN: Ka; _ p <br /> SITE ADDRESS: QZ3/ 0- a S <br /> In completing the Land Use investigation, draw all Public Health factors on the e it (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 /> 5<P-fie 7y/0 K �. / ij — IAC yttibo �i ouFP. <br /> U 61 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD 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 />