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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# 1 <br /> EHD RECEIVED APP.REFERRAL: <br /> 1 "a�r9 COMPLETE & SUBMIT BY - q- 9 <br /> DATE DATE <br /> ATTN: ��LY� t/ /1 �CJ l e 17 <br /> SITE ADDRESS: i&t umdcKoza-) ci -Ar-) P�LL2L2nl <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit(i.e.: sewage dispo <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 /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> V2 1 e-, >, � <br /> 0 <br /> o C <br /> SUPERVISOR/LEAD SENIOR APPROVAL: x,�-- <br /> OA H CHECK OF IST.• Proofread report? l-�Correct LAND USE#? <br /> EH 06 06 Rev 1/99 ! Correct CONDITION(S)? Logged in LAND USE BOOK? <br />