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NOTE: PULL ALL PERmrrs (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL:3__q —o-� _ COMPLETE & SUBMIT BY 3 -r 8 `03 <br /> DATE DATE <br /> ATTN: nnn�1�— &e, �e� <br /> / <br /> SITE ADDRESS: I q W eL 11 lei'0()S k ofi�1 <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 /> V <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 11 CFIECK OFF LIST: _Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 11 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />