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'N(-*'E: PULL ALL PERMITS {SEPTIC, WELL, ETC...} M,,�XE COPIES FOR FILE <br /> LAND USE REPORT APP# -�7 <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY <br /> DAVE DATE <br /> ATTN: <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: I. <br /> let <br /> 01 <br /> ../ <br /> l <br /> I <br /> ii <br /> I recommend: Approval Denial Continuance Inspector's Signature, _ " <br /> Supervisor/Lead Senior Comments: <br /> i. <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> QA�II CFIECI('Q�'.�'LIST �'���`� Proofread report? � � a <br /> Et{06 06 Rev 1/99 <br />