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` NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# S14 -V1?-13 <br /> EHD RECEIVED APP.REFERRAL: L;?;?ZW COMPLETE & SUBMIT BY-41// <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: �9 7`5 N , 41 ) , f0 <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: At� <br /> SjjMTgARY OR COMMENTS: <br /> &`fV11 <br /> I recommend: Approval Denial Continuance Inspector's Signatures_,..-�-• <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST.- `' Proofread report? - Correct LAND USE#?. . <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)2 Logged in LAND USE BOOK?,,R <br />