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N&E: PULL ALL PEF4...JTS (SEPTIC, WELL, ETC...)..#AKE COPIES FOR FIILE <br /> LAND USE REPORT APP# JCtj -6) a `�y6 lSi4 <br /> EHD RECEIVED APP.REFERRAL: . V2— COMPLETE & SUBMIT BY -5 — 7r0, <br /> DATE DATE <br /> ATTN: 1-e� <br /> SITE ADDRESS: q (' _fn� S �� � f �1 dl <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 /> A45n" 001 W. <br /> d <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Commeptfs' / <br /> _S_g 4 y T tie d� <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: _Proofread report? Correct LAND USE#? <br /> Ell 06 06 Rev 1/99 Correct CONDITION(S)? ^Logged in LAND USE BOOK? <br />