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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# 4A <br /> EHD RECEIVED APP.REFERRAJO—a-Zp COMPLETE & SUBMIT BY--:: ` _0 Q <br /> DATE f DATE <br /> ATTN: Jentir (er JO [ [r e <br /> SITE ADDRESS: gof5 g /j <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 /> f <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comme ts: <br /> o b <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> AOA�!"C]�EGK OF.FLIST I_, F xP E <br /> E� � Co t ce t CONDI77011(S) °' gagged isn T.AND'(ISE BOOK? h <br /> EH Db 06 Rev 1199 <br />