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v MC <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# PA - d 3- -5LZ <br /> EHD RECEIVED APP.REFERRAL: d COMPLETE & SUBMIT BY 1 � <br /> DA E DATE <br /> ATTN: <br /> SITE ADDRESS: / 03 CJ Q �- <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 /> a <br /> • #- #z�tr�Ts �sd J � �C � <br /> u'03 <br /> I recommend: Approval ✓ Denial Continuance Inspector's Signature <br /> A�� <br /> Supervisor/Lead Senior Comments: <br /> a3 ' <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> EE:, <br /> ECK OFF LIST ' ,PraofreadCorrect CONDI ���' LoggedEH 06 06 Rev 1199 <br />