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E�NOTE: PULL ALL PERMI t S (SEPTIC, WELL, ETC...) N-k-.:KE COPIES FOR FILE <br /> LAND USE REPORT APP# L(4- -C c) _7/ <br /> EHD RECEIVED APP.REFERRAL: 'o_ —UC] COMPLETE & SUBMIT BY <br /> DATE <br /> ! DATE <br /> ATTN: VItd/` �L <br /> SITE ADDRESS: <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 /> a <br /> A <br /> SUPERVISOR/LEAD SENIOR APPROVAL- <br /> "o CHECK OFF LIST, *,pioafreari repod? f /r .... <br /> EH 06 06 Rev 1199 ;x, , p4 a .� v , C6rrec1 L D�� <br /> � `arrecl011�D�TION(S�g Lagged rn LANA USEBOOK�y� <br /> ri <br /> i <br />