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NOTE: PULL ALL PE (SEPTIC,(SEPTIC, WELL, ETC... EKE COPIES FOR FILE <br /> LAND USE REPORT APP# Z-4 <br /> EHD RECEIVED APP.REFERRAL: -/3—0/ COMPLETE & SUBMI <br /> DATE n <br /> ATTN• DATE I2 -;y <br /> moi, � (err f�� <br /> SITE ADDRESS: Z2 eco L7-/- fs <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 /> 4 <br /> I <br /> f ! <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> C7 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: 17 <br /> U <br /> CHECK OF1"LIST` �"Frgofrrad resort? Correct LAND USE#?1 . <br /> EH 06 06 Rev "9 ,*:� ��; A <br /> Correct CONDITION{S) '� `. Logged`n LAND USEBOOK?. <br />