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NOTIE: PULL ALL PERNtrfS (SEPTIC, WELL, ETC...) TreAKE COPIES FOR FILE <br /> LAND USE REPORTAPP# 4/4 o0 <br /> EHD RECEIVED APP.REFERRAL: - 30 -A COMPLETE & SUBMIT By <br /> DATE // DATE <br /> ATTN: )��A-44_i� <br /> SITE ADDRESS: <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: I,_Q)t�{ Public sewage: <br /> SUMMARY OR COMMENTS: <br /> a � <br /> VV AV <br /> ' .> <br /> I recommend: Approval ✓ Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> a y. <br /> B- U -03 <br /> SUPERVISOWLEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 _Correct CONDITION(S)? Logged in LAND USE BOOK?. <br />