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NOTE: PULL ALL PERMr f S (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APPJL <br /> /] <br /> EHD RECEIVED APP.REFERRAL: -03COMPLETE & SUBMIT BY ®7F,S f ' ?- --9 <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: 300? a 1 Av-L(x v <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 rea <br /> showing population density, location of house, wind direction, etc.... <br /> e <br /> Public sewage: Ault <br /> Public water: g <br /> SUMMARY OR CO MENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> III <br /> 0 ' ov <br /> •. 0 i <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> g OA II CHEEK 4FF LST .�����°�Praofrea_d repoit7 ' �''�Cor'recf LAND, USE#9 z <br /> � �",�"E� �����• �`Correi7 CONDITIO]�(S)�i,`��..�Logged in�L�41V'D�rISE SOd7�� �` <br /> EH 06 06 Rev 1199 <br /> s � <br />