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. _ rri /FYI rrrr <br /> ✓ ' <br /> N i TE: PULL ALL PERMITS (SEPTIC, WELL, ETC-) T4kkE COPIES FOR FILE <br /> LAND USE REPORT APP# �,4 -o( -,39 <br /> EHD RECEIVED APP.REFERRAL: 6-a'o I COMPLETE & SUBMIT BYS A7 V <br /> DATE DATE <br /> ATTN. Jo'st. �L?, <br /> an P-5 <br /> SITE ADDRESS: �Q 5 15, S I rele�is <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, loc Uon of house, wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> r` <br /> I recommend: Approval Denial Continuance Inspector's Signature'se- Y a- <br /> Supervisor/Lead Senior Comments: <br /> oG <br /> i <br /> SUPERVISOR/LEAD SENIOR APPROVAL: . .� <br /> MAXI CHECK:UFF[.IST 4Proofread iepnrt? °Garrett L 9 ND USE#� <br /> EH 06 06 Rev 1199 C° �e�> Q11� T O �')7 - 1�Og all 1t Lz4ND�U EBO(3.k <br /> °� <br />