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T SEPTIC WELL ETC... NIAKE COPIES FOR FILE <br /> NOTA: PULL ALL PERMITS { } <br /> LAND USE REPORT APP# 00 _0 <br /> ry <br /> EHD RECEIVED APP.REFERRAL: d COMPLETE & SUBMIT BY <br /> DATE fr i DATE rr <br /> ATTN: /1 <br /> SITE ADDRESS: aa� 5 0 <br /> In completing the Land Use investigation, draw all Public Health factors on the"exhibit(i.e.: sewage dispo <br /> water supplies, etc...). Where necessary, on an attached piece of pla paper draw completed map of ar <br /> showing population density, location of house, wind direction, etc.... <br /> Public water: " ' Public sewage: <br /> SUMMARY OR COMMENTS: <br /> k <br /> s <br /> Aw <br /> +' <br /> F <br /> 1 <br /> i <br /> I recommend: Approval Denial on ' uancc Inspector'sSi t e <br /> * ��C�t �L�C if]kFFi�C 7L'IFX�C��[]fC MiC i�: <br /> Supervisor/Lead Senior Comments: ` <br /> I <br /> I - <br /> l <br /> 1 <br /> I � <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA Il CHECK OFF LIST '�� �Proofread reparl?� ° � s�Correel LAND,U, #?�g , <br /> EH 06 06 Rev u99 �� 'Correct CONDITION(��� 'Logged in Lr1ND'ISE BOOKS <br />