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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: S'10-q 1 COMPLETE & SUBMIT BY (O 9 <br /> DATE DATE <br /> ATTN: 1P 6 /e-y-- <br /> SITE ADDRESS: ,5 f o P,,g F t 4 1 <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: <br /> Public sewage: <br /> SUMMARY OR COMMENTS: <br /> r <br /> ice.-+ t ' ��� �+- /1 ��� e/ lQ <br /> All <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> pyu�1� \j — <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. _.LL Proofread report? V Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />