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I ' <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> 'S �� COMPLETE & SUBMIT BY 7 — ) 2L —O� <br /> EHD RECEIVED APP.REFERRAL: DATE <br /> ATE <br /> ATTN: _ ` M �0"Y` 6)nn, <br /> SITE ADDRESS: a�(n �� f— +�r'.Lo le-� �^'�r (Co r d <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 / t JCS l , Public sewage: d ��✓ M �'�' �` <br /> SUMMARY OR COMMENTS: S -�✓ d t 114 �S <br /> Y <br /> STD o is �� t,-�� . 4 <br /> �7_ AA O b <br /> I recommend: Approval Denial Continuance Inspector's Signature'Le-) <br /> Supervisor/Lead Senior Comments: <br /> 5D5 !ika� aeil.r. St ?leo <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1199 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />