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i� rl <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) M, iKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: q -D2'—Iq COMPLETE & SUBMIT BY R-f <br /> DATE DATE <br /> ATTN: � <br /> SITE ADDRESS: X90 L.1 J 1 ,.• d <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 /> do <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> *$e*�'c***k�e:4ieirvk**�r�e9e�t4r4e9t;E*�c***k**fir***irieieie�r*kde desk*ir**fie:FAY*fexc�cFdc*****c*********icok�e�c*fir*icir�e9rienFdr** <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOWLEAD SENIOR APPROVAL: <br /> OA.II CHECK OFF LIST. Proofread-report P. Correct•L4ND USE#9" <br /> EH D6 06 Rev 1199 Correct CONDITION(S):? Logged in LAND USE BOOK? <br />