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NOTE: PULL ALL PERNYTS (SEPTIC, WELL, ETC...) N* AKE COPIES FOR FILE <br /> LAND USE REPORT <br /> rn� APP#_S 8 <br /> /3 - 19- / <br /> EHD RECEIVED APP.REFERRAL: I V- D COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTIN:,y\ <br /> SITE ADDRESS: oft / <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: t5 -1 Public sewage: Or�sil- <br /> SUMMARY OR COMMENTS: <br /> [ recommend: Approval Denial Continuance Inspector's Signatur <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK <br /> 'LIST.- _Proofread report? _Correct L4ND USE k? <br /> EH 06 06 Rev eros _Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />