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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) NMKE COPIES FOR FILE <br /> LAND USE REPORT APP# 0 C'�J- ��A� <br /> EHD RECEIVED.APP.REFERRAL-: WU3 COMPLETE & SUBMIT BY1J/D S�03 <br /> TLf <br /> DA4 E <br /> ATTN: <br /> SITE ADDRESS: <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit ({.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 /> /;U - lDa iri - da�cd gvWfu6m.iYco1 �s <br /> // 03 �✓��ii5 Ort S cel a <br /> C s emrrurziCA <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> ***� <br /> Supervisor/Lead Senior Comments: <br /> .r <br /> OIL d <br /> SUPERVISOWLEAD SENIOR APPROVAL: <br /> OA 11 CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> Correct CONDITION(S)? _Logged in LAND USE BOOK? <br /> EI{06 06 Rev 1/99 <br />