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�d <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# -- I <br /> EHD RECEIVED APP.REFERRAL: 1✓/ I COMPLETE & SUBMIT BY S 2 -0 <br /> DA DATE <br /> ATTN: J 1),S2- 'G A,,,, <br /> SITE ADDRESS: 3 S/ 6 /J ,i �c•.- /�f C L.�r^� <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit (Le.: 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 /> x*i�ic is 9cX�k is�F is�c 9c 4c is 9c is arc icxic icx i�icxxicxiczx�cx*icx is rc is is is icxxxic i�xxic icxx�c is icx�c it it icx is is ic>c is is ycxiv is icxic:<ic is it i�:Fzx;i xix it icz <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 11 CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />