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.% N6 <br /> NOTE: PULL ALL PERM 'S (SEPTIC, WELL, ETC...) OWE COPIES FOR FILE <br /> LAND USE REPORT APP# 05- 9!1-1c5& <br /> x ensy�„ <br /> EHD RECEIVED APP.REFERRAL: a COMPLETE & SUBMIT BY C1 -0 <br /> 15ATV DATE <br /> ATTN: �h 1'1 <br /> SITE ADDRESS: / �' . �n e,),— lPi,�e n S <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 /> I recommend: Approval Denial Continuance Inspector's Signature <br /> *ie 9c�c�cx*ic icxxie is�c�cX�c�c�'c is is is a'c is ix is is�c icxxic icx�"cx�e icx�c 9c Lexie a'c*��c�c$c�e is 9c is�F icx*ie is�c is is 9c�e*9c*�c is�c�'c�cx�'c*:E��F�c�"e it is a'c is�r do it�c�c <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1199 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />