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NOTE: PULL ALL PERMI'T`S (SEPTIC, WELL, ETC...) Nr_4KE COPIES FOR FILE <br /> LAND USE REPORT APP# SA- D l - 97 (,T-es) <br /> I r7 03 COMPLETE & SUBMIT BY —a y <br /> EHD RECEIVED APP.REFERRALDATE DATE <br /> ATTN: <br /> SITE ADDRESS: X13 t/ 3 S /fii' <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 /> y <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> F�—�ACK Q LST: _Proofread report? Correct LAND USE#? <br /> Correct CONDITION(S)? _Logged is LAND USE BOOR? <br /> EH 06 06 Rev 1/99 <br />