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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) 1VfwAKE COPIES FOR FILE <br /> LAND USE REPORT APP# T� <br /> EHD RECEIVED APP.REFERRAL:�� ��U COMPLETE & SUBMIT BY 3,11 q/C�`"1 <br /> DATL / DAT <br /> ale <br /> IATN: <br /> SITE ADDRESS: <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 aF it it�c is k�c is�'c�F�'c ac ir�irxic�c 9c�c�'c*�c�'c 9c�F�e�F ie�Fx�c�c rc�c�c 4c�c�cx�c�ex�c�9c a'c k9c do�cx�k a'c�c it ac is is a'cXic icxiczzia is ix is isx*ic�t 9c ie�c�e 9c�e�c de�c�c�r is <br /> Supervisor/Lead Senior Commen <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE BOOK? <br />