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NOTE: PULL ALL PERMI.'TS (SEPTIC, WELL, ETC...) M),,&E COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: 0-3 COMPLETE & SUBMIT BY <br /> DAT DATE J <br /> ATTN: 1 <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 /> -� <br /> I recommend: Approval Denial Continuance Inspector's Signatur <br /> Supervisor/Lead Senior Comments: <br /> 31 101 <br /> do/nI <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. E r� Proofread reports Correct L 4ND i7SL�##p <br /> z k ':.Correct CONDITIONS) Logged in LAND USE A64. <br /> z i <br /> EH 06 06 Rev 1199 <br />