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NOTE: PULL ALL PERM-.-rS (SEPTIC, WELL, ETC...) MPME COPIES FOR FILE <br /> LAND USE REPORT APP#�� - ea -y�y� sl <br /> EHD RECEIVED APP.REFERRAL: 0 `I'/ c1- COMPLETE & SUBMIT BY <br /> n p / TE <br /> ATTN: , �(-),(e �Jb.�/9 eS <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: +40 Public sewage: ✓ <br /> SUMMARY OR COMMENTS: <br /> — <br /> L13J"I tr/lJ <br /> Ar. <br /> ou r L --. <br /> -- <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> Aid me <br /> © 7 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: _Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />