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NOTE: PULL ALL PERNMS (SEPTIC, WELL, ETC...) NrAKE COPIES FOR FILE <br /> LAND USE REPORT APP# . uyq <jty) <br /> EHD RECEIVED APP.REFERRAL: O COMPLETE & SUBMIT BY 1 O Z7��? 3 <br /> ATE <br /> ATTN: OSSy J n <br /> SITE ADDRESS: g <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 /> �r*ak is�e*�c is is�c is*�c*�c 4c**�c 9c*dc de do�i�cx�c is 9c�c is�'c is�'e�c is it�F is*�c 9c 3c�c*�'c�F�c�c 9c�k 4c 9r do is ie is is is�E is 9c is is 9c e+c�F*�c*�c icx' re�c�c 9c cac dex�'e�c 7k�k�r <br /> Supervisor/Lead Senior Comments: <br /> / <br /> aS <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 . <br /> Correct CONDITION(S)? Logged in LAND USE BOOK? <br />