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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> Czl <br /> LAND USE REPORT APP# i��- 9 1 -1 � � <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY aslqp <br /> DATE r DATE <br /> ATTN: �rl S'j /l i a ^^- <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 /> 0 3 <br /> > <br /> -A <br /> I recommend: Approval Denial Continuance Inspector's Signature % r�z�•lc-� <br /> is*�cx x�c�Fxxx�c*x�cx*�c�kx*xicx x�c it�kxic is it icxic icxir icxicx*xic�F*�c icx�'c*x�E 9c�cx�cx is�c zir 7c*�c�'c�Fz�'c�'c�*ic�c'xx�c�'c�c'xx9c�c�Yx'x do�c�'c�c <br /> Supervisor/Lead Senior Comments: <br /> A 1d - o7 <br /> 14,ICA, Ilk <br /> 41 <br /> o :vVV <br /> (/ <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> Hf 106 06 Rev 1/99Correct CONDITION(S)? Logged in LAND USE BOOK? <br />