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4 L <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC-) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED_ APP.REFERRAL: COMPLETE & SUBMIT <br /> D ATE <br /> ATTN• _ ��5� i 6,�_�5 <br /> SITE ADDRESS: 0 e z <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_X Denial Continuance Inspector's Signatur/aA.41� <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> xOA II CHECKOFFL/STrProotead ieport7 Correct LAND USE#?; <br /> Correcf CONDITIDN(S)p iLogger!rn LAND USE BOOKS <br /> EH 06 06 Rev 1/99 <br />