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\Jr <br /> NOTE: PULL ALL PERM.,S (SEPTIC, WELL, ETC...) P '.KE COPIES FOR FILE <br /> LAND USE REPORT APP#-- ! L� - Q 1 <br /> /-�) <br /> EHD RECEIVED APP.REFERRAL: Jd� I COMPLETE & SUBMIT BY--9-L2 g"01 <br /> DATE // � <br /> DATE <br /> ATTN: S/� <br /> SITE ADDRESS: _f 07 )EP- ! .a L,a d 1. <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 /> Fublic • er: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> *��x**���,�:�*,v:vx�**��x�**�:��x**��**��**x*x�***:vx��,�*�:�*x��*�*x�***��*x**:11 • •:11*�**x *:�xxx <br /> Supervisor/Lead Senior Comments: <br /> a - <br /> SUPERVISOWLEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#.? <br /> EH 06 06 Rev 1199 _Correct CONDITION(S)? Logged in LAND USE BOOK? <br />