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NOTE: PULL ALL PERMS (SEPTIC, WELL, ETC...) Mi(KE COPIES FOR FILE M <br /> LAND USE REPORT APP#P H 1-a-a-A <br /> EHD RECEIVED APP.REFERRAL: I O COMPLETE & SUBMIT BY I— J— 03 <br /> DATE DATE <br /> SITE ADDRESS: t'Il D 1,j <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 /> SUPERVISORILEAD SENIOR APPROVAL: . <br /> OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE BOOK? <br /> EH 06 06 Rev 1199 <br />