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L .�n <br /> f <br /> NOTE: PULL ALL PERMI\\TS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT <br /> APP# <br /> i } <br /> EHD RECEIVED API'.REFERRAL: ! -' ! COMPLETE & SUBMIT BY A..0 Aa <br /> DATE <br /> A'TTN: K a -er G� G <br /> SITE ADDRESS: �> J o� ' gn <br /> In completing the Land Use investigation, draw ail 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 /> -5 (c— <br /> 1 <br /> I recommend: Approval A- Denial Continuance Inspector's Si at <br /> i <br /> Supervisor/Lead Senior Comments: <br /> t <br /> 4P <br /> SUPERVISORILE:AD SENIOR APPROVAL: <br /> `r-OA 1'1'CHECK.O F LIST ` .�'t'onfreaaf repack?�, ' Cor.e t�ND��SEs#7 <br /> �°�' �� ..: � �4rrezl CDIVDITION(S)� Lvgged t�ISD-.USE BOOR? <br /> EH 06 06 Rev 1199 <br />