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NOTE: PULL ALL PERMS (SEPTIC, WELL, ETC...) MAkE COPIES FOR FILE <br /> Time <br /> LAND USE REPORT APP#--je—D n-/V <br /> EHD RECEIVED APP.REFERRAL: <br /> a-q-Oa COMPLETE & SUBMIT BY 02 - / L -09- <br /> DATE f� _ DATE <br /> ATTN: �� o r1(�1 JY�Y c� <br /> SITE ADDRESS: q1 :1S lc. m Gi4t-�j:t d <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 /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: _proofread report? Correct LAND USF. k? <br /> EH 06 06 Rev 1799 Correct CONDITION(S)? _Logged in LAND USE 600X? <br />