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K <br /> NOTE: PULL ALL PERMTfS (SEPTIC, WELL, ETC...) Nv-AKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRALA 6 03 COMPLETE & SUBMIT BY <br /> DATE DA E <br /> /7 <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 / Denial Continuance Inspector's Signature !.-' f^` <br /> xi�ir ix�c Fc:F>c 9r i�ic i�xic is it icxi�xx>rK is it�c it a'c 7c�c icxzi<ic x�F�F 7c�c is x�cxxxx�c x'>c x�c�cxaFx�cxxxic is it�c is�kxxxic icxicxxxicxic>c icxxxxic�cxic it <br /> Supervisor/Lead Senior Comments: <br /> 0 <br /> `0�. <br /> V <br /> GS <br /> 4 <br /> at A— <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> dl� may,U7��G y OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> Q6 0606 Rev��� ���� _ Correct CONDITION(S)? Logged in LAND USE BOOK? <br />