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NOTE: PULL ALL PERMIMM (SEPTIC, WELL, CTC...) NfrfKE COPIES FOR FILE <br /> LAND USE REPORTAPP# (AP-00- 9q <br /> EHQ, - q-03D RECEIVED APP.REFERRAL:� COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: �i pt ���I--WLl S4-f <br /> SITE ADDRESS: of <br /> In completing the Land Use investigation, draw all Public Health factors on the e bit 0.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 /> OS 07 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> oy <br /> oS <br /> Vv <br /> SUPERVISOR/LEAD SENIOR APPROVAL: q. <br /> OA 11 CHECK OFF LIST.• _Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 11 _Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />