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„`'NOTE: PULL ALL PERNaTS (SEPTIC, WELL, ETC...)' viAKE COPIES FOR FILE <br /> ry 3 <br /> 1 LAND USE REPORT APP# 1- -00 <br /> UE & SUBMIT BY ! p ''�� <br /> EHD RECEIVED APP.REFERRAL:0 1 O COMPLET <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: { <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit (Le.: 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 /> 3 <br /> 3 <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> EI � <br /> 3 ,! <br /> i <br /> 3 <br /> i <br /> 3 <br /> I recommend: Approval Denial Continuance Inspector's Signature 1 <br /> j Supervisor/Lead Senior Comments: <br /> 3 <br /> ; <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA CHL CK OFF LISTPToafread report? �� Correct L 4ND CISE#? <br /> EH 06 06 Rev 1199 <br /> �E �Co iect CONDIT]ON(SJ�� Logged In L.4i'1'll:USE BOOR� <br />