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y <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) EKE COPIES FOR FILE <br /> LAND USE REPORT APP# S/4 -Uo a7 <br /> EHD RECEIVED APP.REFERRAL: & _13_QO COMPLETE & SUBMIT BY 00 <br /> DATE DATE <br /> ATTN: n �,. -h r rv►P <br /> SITE ADDRESS: <br /> In completing the Land Use investigation, draw all Public( ealth 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 /> C) <br /> FX157T-U& sYsr4t^7 mt)t) , <br /> ID2�v 2 <br /> loZ ;oy <br /> /vZ.aS <br /> uoTt: TIFue�' �CEPA�RS � C�E�E2�-rF /�l��sJRmas w.9sT� <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> u—�S <br /> p2-c�2 <br /> AAn <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />