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l <br /> N <br /> NOTE:', PULL ALL PERMTTS (SEPTIC, WELL, ETC...) NrA.KE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: /-T W COMPLETE & SUBMIT BY / -/,'1 '00 <br /> DATE / DATE <br /> ATTN: M <br /> SITE ADDRESS: a11 h1)j C- <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 /> UMMARY OR COMMENTS: <br /> _ v <br /> . v <br /> J/ 2 r' <br /> ` <br /> L S .PAX, _C___CLI--C 22 o Z / S <br /> I recommend: Approval Denial Continuance Inspector's Signaturel <br /> ,Ir rc�c is itxix�r*xEx�r is F is�c*x*a'c kxx**fir*xicxxzic icxir*xicxk�c is*xxxxir is�c a'cxXx�c is*i<ir irxxicxic icxxic irx>c>c icxxic icx it xis is icxx�c <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA 11 CHECKOF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 , Correct CONDITION(S)? Logged in LAND USE BOOK? <br />