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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# - <br /> EHD RECEIVED APP.REFERRAL: —29 COMPLETE & SUBMIT BY_ 2 — 6 - 9 <br /> DATE DATE <br /> ATTN• � I c jL �S 1� / <br /> SITE ADDRESS: 3 5. <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: X/ 0 <br /> SUMMARY OR COMMENTS: <br /> 4 <br /> M <br /> I recommend: Approval Denial Continuance Inspector's Signatur _ <br /> r**aF***** <br /> Supervisor/Lead Senior Comments: <br /> E <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> QA:11 CHECK OF .LIST. "Proofread report?' . Correct L,4ND USE 97-, <br /> EH n6 06 Rev 1/99 Carrea CONDI7QN(S}9 bagged.in L41VD USE BOORS ; <br /> i <br />