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26 <br /> NOTE: PULL ALL PERMIYS (SEPTIC, WELL, ETC...) MkKE COPIES FOR FILE <br /> LAND USE REPORT APP#�S t4 -DO 75 <br /> 1 <br /> EHD RECEIVED APP.REFERRAL: 1 -q 00 COMPLETE & SUBMIT BY j Q —/9 - O Q <br /> DATE I DATE <br /> ATTN: 11? S hVi� <br /> SITE ADDRESS: 3!S:5(0 v5 S , - e4- c'? E <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 denssiityy� location of house, wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: 1 <br /> Ot <br /> I recommend: Approval lDenial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rev 1/99 ''Correct CONDITION(S)? _Logged in LAND USE BOOR? <br />