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NOTE: PULL ALL PERNITTS (SEPTIC, WELL, ETC...) NZ'AKE COPIES FOR FILE <br /> LAND USE REPORT 7 APP# U �/'- 9GI- e <br /> IV �cfc...c�un <br /> EHD RECEIVED APP.REFERRAL: d7-of COMPLETE & SUBMIT BY &I -iI -01 <br /> DATE DATE <br /> ATTN: J e {-F j, C (tie r✓ <br /> SITEADDRESS: y/o(7 S. _5-k lei- <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 /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST.• Proofread report? Correct LAND USE#? <br /> FH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOR? <br />