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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) AKE COPIES FOR FILE <br /> LAND USE REPORT APP# -C7 a � (L4)CTi" <br /> 1/a6/0y <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY� —RY t� <br /> Now <br /> DA E DAIr <br /> ATTN: <br /> SITE ADDRESS: 1 <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit (i.e.: s age 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 Signature <br /> Supervisor/Lead Senior Comments: <br /> -4 <br /> SUPERVISORlLEAD SENIOR APPROVAL: <br /> OA II CIL,tJCK OFF LIST' .t>1 J Psoo re�rd r or�� ��� `Correcd LAND.i SE#9 . <br /> ' � "Correct CONDITI011�(SJ v `Lagged in'LAND USE'B00K7, <br /> EH0606Rev 1199 r<r , .� _; x x <br />