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NOTE: PULL ALL PERM`' (SEPTIC, WELL, ETC...) M {E COPIES FOR FILE <br /> Ti/vi f <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: '�-�s ( COMPLETE & SUBMIT BY — <br /> DATE DATE <br /> ATTN: �`�''-`VA e v ) e <br /> SITE ADDRESS: `�`a S S b r F-P ►'�CL` C�-�v <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 /> o44e*�'c�'c 9c�k*s't�c�F�k*x�c�c is is 9c�r*ie is�'e�r sr*ic�c�F�c�Fx�'c�c*i'c9c>Fxir�"c�cxx�r�r ak�c�'c�c�c is*ix*x*fie yc�F�rx�k�'c�FXic�c*�'e 9c�c x9cx>c�rx�F icx�'c�c 9c yc*�kxx <br /> Supervisor/Lead Senior Comments: <br /> �F <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> Eli 06 06 Rcv 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />