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NOTE: PULL ALL PERM-n'S (SEPTIC, WELL, ETC...) MsKE COPIES FOR FILE 1 <br /> LAND USE REPORT APP# ✓� —U17—�QCf <br /> EHD RECEIVED APP.REFERRAL: 0 —/1-03 COMPLETE & SUBMIT BY_ <br /> DATE DATE <br /> ATTN: �— �Q (\n.p 01it I ( e.f <br /> SITE ADDRESS: a 03 <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 /> I recommend: Approval�Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> b <br /> i <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> Ell 06 06 Rev 1/99 Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />