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,NOTE: PULL ALL PERMItS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# 514-01 -0'7 <br /> EHD RECEIVED APP.REFERRAL: I -A -0I COMPLETE & SUBMIT BY a ' 15 `O <br /> DATE `` DATE <br /> ATTN: `NO ti(1;� J O f I f � <br /> SITE ADDRESS: a a a N 1 S (1'1 vrphy 2 0 tir{ , etgA! <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 /> 67 <br /> If If <br /> I recommend: Approval Denial Continuance Inspector's Signatu <br /> Supervisor/Lead Senior Comments: <br /> � r <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> ff!CK OFF LIST. _Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 199 _Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />