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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: / v- COMPLETE & SUBMIT BY + S/'7 A / y-a 0-9 9 <br /> DATE DAT <br /> ATTN: +"al, I-LJ U M Ct <br /> SITE ADDRESS: DD ,moi a� e5 , ria�t>L�e R oa old <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: O'UlMA rop sorD_La&M d <br /> SUMMARY ORCOMMENTS: <br /> 0 <br /> 0 : 6 <br /> 61�o ' <br /> aA <br /> a • <br /> I rec mmend: Approval Denial Continuance Inspector's Signature <br /> Supe or/Lead Senior Comments: <br /> \ r s & i <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA if CHECK O LIST: Proofread reporO Correct LAND USE#? <br /> EH 06 D6 Rev 1/99Correct COND[TION(S)? Logged in LAND USE BOOK? <br />