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NOTE: PULL ALL PERNMS (SEPTIC, WELL, ETC...) Ni—AE COPIES FQR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: I v✓ COMPLETE & SUBMIT BY / l)✓/c-j <br /> D E DATE <br /> AT N: .c <br /> SITE ADDRESS: o�(� (Z� �"� - <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 /> ol /rf-�� <br /> I recommend: Approval <br /> _,ZDenial Continuance Inspector's Si re <br /> �c*ic icxxrc�cxicxic 4c is is 9c>c is icxX9c is icx:c is icx is is icx�c is icx icxxicx x>c is icx*x xic ix ic>c�c is is icxic�c icxx�c 9cx�c is x>c�ctic*tic*x�c�c x`ac�c�c*�c icx�Yz <br /> Supervisor/Lead Senior Comments: <br /> d i 4" --:--0 <br /> .c.-r.v <br /> VV <br /> 4V V <br /> e <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />