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NOTE: PULL ALL PERM I'S (SEPTIC, WELL, ETC...) AKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> A`zW-13T k' <br /> EHD RECEIVED APP.REFERRAL: ' u/ COMPLETE & SUBMITIM4 J&3 <br /> DAIE / DATE <br /> ATTN: <br /> SITE ADDRESS: e—d hV <br /> In completing the Land Use investigation, draw all Public Health factors on e exhibit (i.P. 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 /> to frl lvac l xlfe- • zlw 15•qvpvee 6 ,Alliu� i <br /> Aw <br /> A3 a, <br /> A0 <br /> IY&Zal 7' 7 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> *�cixxxie�'c�c�ciccicxxicie*�cieicicicieicicxiexx�cicxcx�eiciexxiexx9e*�e3e9ex:kiex�e�eiexxxieiexxie�cxie�9exiex�cicieiexx��eie*xieyexxxxieicie <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 11 CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />