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LL ALL PERMITS SEPTIC, WELL, ETC...) NNKE COPIES FOR FILE H <br /> NOTE: PULL � <br /> LAND USE REPORT APP <br /> EHD RECEIVED APP.REFERRAL: X2- 0 COMPLETE & SUBMIT BY — <br /> DATEI <br /> )FU— (x <br /> �, DATE <br /> ATTN: �^ ri (xi <br /> SITE ADDRESS: 1 Q r a Q I /AC t A <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: j e �. Public sewage: <br /> SUMMARY OR COMMENTS: <br /> Zi 0 <br /> I recommend: Approval c/Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECKOFF LIST.- _Proofread report? Correct LAND USE#? <br /> riiuhoeRev i/ve — <br /> IF <br /> Correct CONDITION(S)? _ Logged in LAND USE BOOK? <br />