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NOTE: PULL ALL PERMTT'S (SEPTIC, WELL, ETC...) NrAKE COPIES FOR FILE <br /> LAND USE REPORT �j APP# P,,+ //-03 - /7L J- 1f <br /> EHD RECEIVED APP.REFERRAL: V—/ O✓ COMPLETE & SUBMIT BY SA ZL63 <br /> DA —� I)NtE <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 COMMENTSFF: L ' <br /> �� SOI l � Z^,ray✓t e—C�f..�A� L„n.i�' /�r'C°.e� <br /> I recommend: Approval_ Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> ' a <br /> r' a j <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 11 CHECKOFF LIST: Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rev It99 Correct CONDITION(S)? Logged in LAND USE BOOR? <br />