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jy <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) XtAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: l D Yn COMPLETE & SUBMIT BY �/ p Z,21DATE <br /> DATE <br /> ATTN: <br /> SITE ADDRESS: q r, L ��� .,. Zd, — <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 /> • , <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 11►CHECK OFF LIST r Proofread report? �Coriect SAND DISE#9� <br /> EH 06 06 Rev 1/99 4a _ e{Cnrrecl COND!'T101V(S)? Logged to LAND USE BO©K? <br />