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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) NrAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: i -a Y-0COMPLETE & SUBMIT BY `�J �✓ `� <br /> DATE DATE <br /> ATTN: �42 :to� <br /> SITE ADDRESS: I <br /> In completing the Land Use investigation, draw all Public Hea th 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/V,d'ennsity, location of house, wind direction, etc.... / <br /> Public water: Public sewage: wok <br /> SUMMARY OR COMMENTS: <br /> amog <br /> V•� � <br /> I recommend: Approvalz Denial Continuance Inspector's Signatur <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST. Proofread report p Correct LAND USE#? <br /> EH 06 06 Rev 1199 11 _Correct CONDITION(S)? Logged in LAND USE BOOK? <br />