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4 A �� <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) ivt—K <br /> E COPIES FOR FILE <br /> APP# —� S3 7 &10j <br /> LAND USE REPORT a p j <br /> * /0 a3 <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY DATE <br /> DAYE <br /> ATTN: ' an <br /> SITE ADDRESS: <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 /> Supervisor/Lead Se 'or Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECH OFFLLT. � Proajread report? ' Garrect'LAND(ISE#? <br /> 'La- -ed rn LfiND USE BOOK? " <br /> F1I 06 06 Rcv 1199 <br />