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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT - - � . <br /> le� (T- <br /> EHD RECEIVED APP.REFERRAL: 6-9-qq COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: J e-4 15TSIV r ^/ <br /> SITE ADDRESS: l 75 /I� �i1J,lr�� c1l�t c,r /��39 ,,/ li, � hV-1 d d . <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: J= <br /> SUMMARY OR COMMENTS: <br /> o(o <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF T. ' Proofread report _, Correct LAND USE#? <br /> [H 06 06 Rev 1i49 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />