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MAKE COPIES FOR FILE <br /> NOTE: PULL ALL PERMITS {SEPTIC, WELL, ETC...} <br /> LAND USE REPORT APP#P _O 3 `� t <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMI DAT£ , ff <br /> DAT 1•.GiS 1/P��S <br /> ATTN: +n n �'1�,(J 2��2 .✓J"` <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 /> de <br /> 00 <br /> I recommend: Approval <br /> Denial Continuance Inspector's atu e <br /> Supervisor[Lead Senior Comments: <br /> 7 9 � <br /> r <br /> I <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> DA'll CHECK OFF LIS Tr'Proofread reparl?i Correct L41!'6 <br /> TCorr`ect CONDITION{S)q. # ,Logged in LAND USE BODK7' <br /> EFi 0606 Rev 1.199 = <br />