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NOTE: PULL ALL PERM'S (SEPTIC, WELL, ETC...) N AKE COPIES FOR FILE <br /> LAND USE REPORT APP# `S. - O O - 3 <br /> EHD RECEIVED APP.REFERRAL:6 JO-60 COMPLETE & SUBMIT BY 1�- -2 J -00 <br /> DATE // DATE <br /> ATTN: n/10 <br /> SITE ADDRESS: i 6 a 3 e&7. S-Z /zf - v, �« <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: A� Public sewage: <br /> SUMMARY OR COMMENTS: <br /> nnom' 14 <br /> •2 Q-e� G-t S <br /> U� <br /> I recommend: Approval Denial Continuance Inspector's Signatu e <br /> Supervisor/Lead Senior Comments: <br /> © ' <br /> , /11000s <br /> jj- <br /> v�to <br /> SUPERVISOR/LEAD SENIOR APPRO AL: <br /> a,,,1; OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 060 evI <br /> Correct CONDITION(S)? Logged in LAND USE BOOK? <br /> ISS -a.f lI(S7 <br />