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�C:- <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) NMKE COPIES FOR FILE <br /> LAND USE REPORT APP#� - <br /> EHD RECEIVED APP.REFERRAL: O COMPLETE & SUBMIT BY / — UU <br /> DATE DATE <br /> ATTN: J(,4- d` C <br /> SITE ADDRESS: 5 Lf (v <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 are,- <br /> showing <br /> re,showing population density, location of house, wind direction, etc.... <br /> Public water: K/4 Public sewage: N (� <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 r I <br /> Correct CONDITION(S)? Logged in LAND USE BOOK? <br />