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NO'T'E: BULL ALL PERMI'?S (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: 1 —C) COMPLETE & SUBMIT BY � ? / <br /> DATE / DATE <br /> ATTN: j Q-,W— / <br /> SITE ADDRESS: 1 I q Ij , s _ �� I� r <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/ ZAk C t Public sewage: <br /> SUMMARY OR COMMENTS: <br /> ere tt <br /> 6 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> 9c�c9e9c�r�'c*�e�c�'c�4�k�Y�c�4�"cic�c�'c�'e**�Y9cie9cic�cn2�c�'cicicxiv*9caY�c*k*�c�F 9r�c�cie9c*�4***�k.�Y�'c***�c*�'c�k�*�c9e�.49c�cdc9edeic�cicie3cicxicicieicicicic�eic <br /> Supervisor/Lead Senior Comments: <br /> 7 Wt!L"A <br /> � • 4 l� <br /> CL <br /> .; , <br /> IE <br /> aD : o <br /> 0 ;2- <br /> - <br /> U - <br /> � <br /> 1J ' <br /> 03 du��MI <br /> SUPERVISORILEAD SENIOR APPRTAL: Q � <br /> F�IrECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />