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� c <br /> NOTE= PULL ALL PERMh...S (SEPTIC, WELL, ETC...) N,KE COPIES FOR FILE <br /> LAND USE REPORT APP# ( ( �C-112 <br /> EHD RECEIVED APP.REFERRAL: S - o15-00 COMPLETE & SUBMIT BY—L <br /> � ✓ I ` O <br /> DATE (� DATE <br /> SITE ADDRESS: <br /> o�3O7 � S � 'e I'i �,.—+— � V Avt_ <br /> — <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 /> Z*-AL22--Z-- O <br /> - <br /> All <br /> c <br /> 'D <br /> i <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> oy <br /> -7 <br /> 1 <br /> c1 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST., Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 11 <br /> Correct CONDITION(S)? Logged in LAND USE BOOK? <br />