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MOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# Vie - y u <br /> EHD RECEIVED APP.REFERRAL: / ��J/—v COMPLETE & SUBMIT BY <br /> DATE / DATE <br /> ATTN: .J ;� 1! /h 61 -7f�1 �l?e) <br /> SITE ADDRESS: 9,� C <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: � A Public sewage: <br /> SUMMARY OR COMMENTS: <br /> / 2L4y/ r21u 17� <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �'t9c*9c�e4c�F�Fie�'e9c�c9c�c�Y�'c�edcxxie�r�r�e�F�ca'e�eie�c�c�F�c�ra'eke*�r�c�'e�c4c�cic�c*ie 9cic�c�c3e�'c�c*icx�Fxic�cicicicicic�kicic�cic9r�c�k�c�c�e�e�4�e�e�e�e'�e�'e�t�e3'e9e�e <br /> Supervisor/Lead Senior Comments �© <br /> �- <br /> 01oi • <br /> L11 °m• <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />