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NOTE: PULL ALL PERN.. .'S (SEPTIC, WELL, ETC...) I EKE COPIES FOR FILE <br /> LAND USE REPORT p APP# si4 -o / - 22 <br /> J <br /> EHD RECEIVED APP.REFERRAL: `/O VT/ COMPLETE & SUBMIT BY !o S—Z) / <br /> DATE DATE <br /> ATTN: j 2 Ick Ame r <br /> SITE ADDRESS: S -e y fzL CAo,0— led C <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 /> V y " P <br /> 1 <br /> I recommend: Approval Denial Continuance Inspector's Sign ture <br /> Supervisor/Lead Senior Comments: <br /> Q <br /> VV JAQ1 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> CHECK OFF LIST: _Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)?. _Logged in LAND USE BOOK? <br /> ` ll�� <br />