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NOTE: PULL ALL PERN{ ,S (SEPTIC, WELL, ETC...) T -..KE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY L( — <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: �� 3 7 y 5 . S { 1 �v ,y�fi�� <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 /> d : <br /> 02 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: ; <br /> OA II CHECK OFF LIST., _Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1199 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />