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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) ME COPIES FOR FILE <br /> LAND USE REPORT APP# S—4- q S' 3 3 t7s& ^`M <br /> EHD RECEIVED APP.REFERRAL: 1 —� -q"1 COMPLETE & SUBMIT BY I C; `I � - W <br /> DAA r L DATE <br /> ATTN: \ � Vrf <br /> SITE ADDRESS: 17 u R 5 fla ;a d + fn <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 /> 50 - I L, '7 vmQ eeZW 4 AN\ <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: L'Proofread report? Z Correct LAND USE k? <br /> EH 46 06 Rev 1/99 —Correct CONDITION(S)? Logged in L4.,VD USE BOOK? <br />