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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> Pf <br /> 10 <br /> LAND USE REPORT APP# - � � S� °-f <br /> COMPLETE & SUBMIT BY <br /> EHD RECEIVED APP.REFERRAL.— _ DATE <br /> DA <br /> ATTN: (A II t <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 /> b <br /> I recommendpp <br /> • Approval Denial Continuance Inspector's Signature -- �'�'6'` <br /> � . <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> EE, <br /> A 77 CHECK OFF LIST Prpofread report?¢ .m Corvert L=t6 <br /> a.,_Correct CONDITION(SJP LaggAND <br /> EH 06 06 Rev 1199 " <br /> �" <br />