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IBJ <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) M-%KE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: U COMPLETE & SUBMIT BY �"� 3/ 9 <br /> Zo <br /> DAT DATE <br /> ATTN: <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: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: Proofread report? Correct LA7BOOK?] <br /> Correct CONDITION(.S)? Logged in LAND U <br /> EH 06 06 Rev I/99 <br />