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JV <br />NOTE: PULL ALL PERMS (SEPTIC, WELL, ETC...) AKE COPIES FOR FILE <br />LAND USE REPORT APP# _S,q :5�:jd -(')-( <br />EHD RECEIVED APP. REFERRAL: 2' COMPLETE & SUBMIT BY 3 / r�2 GI1(90 <br />DATE DATE <br />ATTN:(✓lJ�(�Yl <br />SITE ADDRESS: 0 0 47-f) /A), L-jl 7 o e- i V . Tr A Civ <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: <br />Public sewage: <br />SUMMARY OR COMMENTS: <br />Iry <br />I recommend: Approval Denial Continuance Inspector's Signature <br />Supervisor/Lead Senior Comments: <br />, <br />�� �oa•oy <br />SUPERVISOR/LEAD SENIOR APPROVAL: <br />EH 06 06 Rev 1/99 <br />OA II CHECK UFFLIST: 'Proofread report? . " Correct LAND USE P <br />Correct CONDITION(S)? Logged in LAND USE BOOK? <br />