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. NOTE. PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP#_ <br /> EHD RECEIVED APP.REFERRAL.- "� COMPLETE & SUBMIT BY <br /> DATE DATE <br /> � <br /> ATTN: Cnc e r F' r � <br /> SITE ADDRESS: 1920q i'� �t3 . J-c) _r <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, wired direction, etc.... <br /> Public water: �•''" Public sewage: <br /> SUMMARY OR COMMENTS: <br /> leg 2 R—,e,— Ee!!!�� <br /> I recommend: Approva Denial Continuance Inspector's Signatur<z T <br /> 2 <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA IT CHECK©FF ST: �Proofiaq report?- �:rirrect LAND USE# .". <br /> EH 06 06 Rev 1199 <br /> ect CONDITION(S) in LAND USE 1300K� <br />