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NONE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# 5/4 - &/1?- 76 <br /> EHD RECEIVED APP.REFERRAL: -/& -(/L/ COMPLETE & SUBMIT BY 5 - 1 -00 <br /> DATE DATE <br /> ATTN: �-Uo ,� f <br /> SITE ADDRESS: 360 01 G• M,U/)hwal /ft/` Lje- S } KN <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 Denial Continuance Inspector's Sign <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA 11 CHECX OFF LLST - - "Proofread report? -�'Correct LAND USE#? <br /> EH 06 06 Rev 1/99 _Correct CONDITION(S)?, Logged In LAND USE BOOB? <br />