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aCG <br /> NOTE: PULL ALL PERMh*`S (SEPTIC, WELL, ETC...) MACE COPIES FOR FILE <br /> LAND USE REPORT APP# OB -5�f <br /> EHD RECEIVED APP.REFERRAL! () <br /> )h—W COMPLETE & SUBMIT BY /�— 7 -0 0 <br /> DATE DATE <br /> ATTN: no, �r l/�Pill <br /> SITE ADDRESS: >61Y 1/1 �C' <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 /> 01 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> Q <br /> / SUPERVISOR(LEAD SENIOR APPROVAL: <br /> OA 77 CHECK OFF LIST., _Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />