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✓ . M45 <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) 1`� KE COPIES FOR FILE <br /> LAND USE REPORT APP# O �`5CI � <br /> EHD RECEIVED APP.REFERRAL: WM <br /> 0 COMPLETE & SUBMIT B <br /> V4 <br /> DAT ) W _ r DATE <br /> ATTN: I <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 /> w i ' <br /> .Ct17 Ltll�/ ZCrt� <br /> I recommend: Approval Denial Continuance Inspector's Signatur <br /> ir�e�t�r�F�k�cdeia�t�t7k�ciadc3e�t�'e.�r�ic�e�F*9e�e�r3a�kar�e�r4c-k�t�r�ede�cdt�ede$evF�e7kie�irde4t3eieiek�Eit9:�rdc9raF$c9e�Fe49cde9eJr�F�'r$cvkxA$r�e�enFiciex9cleie�eic <br /> Supervisor/Lead Senior Comments: <br /> Q <br /> SUPERVISOR/LEAD SENIOR APPROVAL: -. <br /> OA 11 C�IECK©FFLIST r.,;3,F Proofread reparta $ 'Correct LAND,!UI <br /> `Logged rn LAND USE toOK? <br /> Correct CONDITION{S} <br /> EH 06 06 Rev 1199 <br />