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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: +6 - COMPLETE & SUBMIT BY "t 0 <br /> DATEnn DATE <br /> ATTN: E jg:ifnn t�A e r <br /> SITE ADDRESS: 2-1 / a e ` Z�h)e n ,) e- % r\1 <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 /> :'e ie�e�e�r't�ek�r*F*�c�eie9t�exic�eiricirae�e�c'e�c�e�e�rFxFde9c*�c�c JcirieieFie�c'c*�rlr9cfr9e9c�rirx9ct�etr**�eie�ex*ak*'riede�edelriele�cie*Fietic'ct�e*k <br /> Supervisor/Lead Senior Comments: <br /> 04 <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST.- t—Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 ✓ Correct CONDITION(S)? V Logged in LAND USE BOOK? <br />