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l <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR <br /> LAND USE REPORT APP-4 - �� Pit <br /> EHD RECEIVED APP.REFERRAL: -7 qq/ COMPLETE & SUBMIT BY -' q� <br /> DATE //�� DATE <br /> ATTN: Q (n ("7a t L <br /> SITE ADDRESS: 00601 `5, AL f— /—t:AJAy . 7'/AC,tz• <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 /> in <br /> P26 rRPp��N���� <br /> j(7'UZ — SEwtq Qapt"Pl r, of iu <br /> 20%0/ - Pif 4J47119Z <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> 4ad� 14 )D <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. roofread report? Correct LAND USE#? <br /> EH U6 06 Rev 1/99 _,�Ztorrect CONDITION(S)2ylogged in LAtYD USE BOOK? <br />