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NOTE: PULL ALL PERMS (SEPTIC, WELL, ETC...) N COPIES FOR FILE <br /> LAND USE REPORT APP# P <br /> EHD RECEIVED Arr,REFERRAL: 7/0-Z-. COMPLETE & SUBMIT BY <br /> DATO <br /> 1 DATE <br /> L <br /> ATTN: r 4 n k-/ <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 /> vFdedrdr9e�keFx�t*ir9e9cicir3c�ric�'ckaFde3cic�r�edc$cnF:E$ck�E�r�c$c�Y9e�ek�c�r�:ra��r�$e�rde�'c��edc�r�edcalrielrxieiriexx�ex*dr de ix ie 9c ixir�cze�c3c�kdt$e9t�Y$e1e�'e�kk <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST ' `:. Praofreadxeport?, Correct LAND'USE <br /> Correct CONDITIONS La ed in L1ND USE BOOK <br /> £H 06 06 Rev 1199 � (�� $� � <br />