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,-NOTE: PULL ALL PERNr[TS (SEPTIC, WELL, ETC...),i.AKE COPIES FOR FILE <br /> LAND USE REPORT APP#_5A - 9q -53 T.rt &=cjfr�vn <br /> EHD RECEIVED APP.REFERPUL: I COMPLETE & SUBMIT BY — <br /> DATE DATE <br /> ATTN: � r <br /> SITE ADDRESS: (2 i'7 1 C c ( 1 0 /'"nH <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 /> I recommend: Approval Denial Continuance Inspector's Sign atur 11 * O <br /> Supervisor/Lead Senior Comments: <br /> Cab t ,t.a,,, 1J. /�9 4 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />