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NOTE: PULL ALL PERM (SEPTIC, WELL, ETC...) M COPIES FOR FILE <br /> LAND USE REPORT APP# 7019 <br /> EHD RECEIVED APP.REFERRAL: — -002 COMPLETE & SUBMIT BY <br /> DATt DAVE <br /> br <br /> ATTN: Cti �/!d_�P,�" a <br /> SITE ADDRESS: r <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 /> U <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> *******�'cir�Fak*�e*aEk**Ic�cnkk*�'c9r9rec****�c�kir**a'cx�eie$e9e*vF**a'ctrie*xk�risvcic*ic4�cxxxx**xxxxE**aF-Jr*Fc*icde�rkcx�car�t�c$r* <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA STI CHECK OFF LAWT. `Proofread report - Correct LAND USE#9 <br /> EH os 06 Rev 1199 ^ ;"{ � �Correet CON�ITION{S)9Lagged rn LAND DISE SODK? i <br /> x I, <br />