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4 <br /> '-"'NOTE: PULL ALL PERMS (SEPTIC, WELL, ETC...) ILL. COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: 5—�Z'klz COMPLETE &.SUBMIT BYJ <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: y <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: <br /> Public sewage: <br /> g <br /> SUMMARY OB(COMMENTS: <br /> Z) "..Le e--,T F 11 V S oe <br /> I recommend; Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: jo <br /> OA II Cif�CK OFF LIST s F Praofret�rl report? Correct LAND USE#9 . <br /> eCt <br /> EH 06 06 Rev 1199 '" � ,� R x`'Cvrr �ONDITT©11r(S)7 A Lugged fn LAND [ISE BOOK? ' <br />