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NOTE: PULL ALL PERMYTS (SEPTIC, WELL, ETC...) NMKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: I _ / I COMPLETE & SUBMIT BY -19 'U <br /> DATE bATE <br /> ATTN: �)�/ ,�-I/i i �� ,� J D//P z <br /> SITEADDRESS: <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 /> 0(0 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> *�c i�ic�c*�e i�xzir��F icxxic*�E>F*ic�c is x�k ir��Fx�c it�c is�Fxs�ic�'cx�Fxic a��c is�r is is i��cx*ic icxic�cxxic is is�c icxxic is is�Exic is is is icxxie�e is is�c�e is is <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECKOFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />