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NOTE: PULL ALL PERMTS (SEPTIC, WELL, ETC...) NrAKE COPIES FOR FILE <br /> LAND USE REPORT <br /> APP# -" I N, ' <br /> 9 -t-ves� <br /> EHD RECEIVED APP.REFERRAL <br /> q - 3-03 COMPLETE & SUBMIT BY VA - 13 cc) �3 <br /> DATE AT <br /> Nckf\ <br /> ATTN• <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 <br /> Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 11 CHECK OFF LIST: Proofread report?L� ed Correct <br /> in LAND USE BOOK? <br /> Correct CONDITION(S)? Sg <br /> Ell 0606Rev I/99 <br />