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i <br /> NOTE: PULL ALL PERMS (SEPTIC, WELL, ETC...) lKE COPIES FOR FILE <br /> 1 / <br /> LAND USE REPORT APP# 31Ifs,..) <br /> EHD RECEIVED APP.REFERRAL. $� 3 COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: r <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 /> r+ o 6N <br /> f <br /> UMO <br /> 1 7 S <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> 0 <br /> y <br /> 0 a2 OL-"— <br /> 03 — r� �r <br /> 20 - oS <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> 4A II CHECK OFF LIST � 'i P oofread report x aCorrect LAND ITSE#9 <br /> g � � � ' Correct CONDxTlOtY(5)� � � Lagged rn LAND F1SE BODK? <br /> EH 06 06 Rev 1199 2 �` � r <br />