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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) NIKE COPIES FOR FILE <br /> LAND USE REPORT APP# hi-�_/6� � <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY -I -Oe <br /> DATIE I DATE <br /> ATTN: � <br /> SITE ADDRESS: �� C7 g / I � ��r>� �� —, a d ; <br /> In completing the Land Use investigation, draw all Public Health factors on th hibit (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 � <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA 11 CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1199 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />