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� f v <br /> r OTE:.jPUL L ALL PERMITS (SEPTIC, WELL, ETC...} MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# L 4 _oc->9� <br /> EHD RECEIVED APP.REFERRAL: d..' 'Q0 COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN• ,\ -.Pp S�-t?—� — <br /> SITE ADDRESS: &66 rL+— - 1-- 4u 4:�Q L - <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 /> 7-A IE;15 <br /> 1 R _/ <br /> , CX6 <br /> I recommend: Approval Denial Continuance Inspector's Signature c <br /> Supervisor/Lead Senior Comments: <br /> eA <br /> b f� LjQ - a►1 f �c � °`� 1 <br /> -1-1� rvo on+ <br /> CA -A-- 2, <br /> ilk <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> i "P O Pravfread epo ` � �&Correct LAIND USE#? <br /> OA II CHECK#� ' LIST <br /> Correct CD�VDITIOIV(S)9 Logged in LAND USE BODlY? <br /> EH 06 06 Rev 1149 <br />