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Z— ij <br /> NOTE: PULL ALL PERMIYS (SEPTIC, WELL, ETC...) MwKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> l V,3 0 0 COMPLETE & SUBMIT BY <br /> EHD RECEIVED APP.REFERRAL:DAT DAT <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 de g y, location of house, wind direction, etc.... <br /> Public water: Public sewage: /ham <br /> SUMMARY OR COMMENTS: <br /> zz <br /> 061, <br /> I recommend: Approval Denial Continuance Inspector's Signa ure <br /> aF is i<xh*�c is�c 9c sc 9c�c icxic ix rrx�F�r*dc*9:i'c 9c�Fxsc�c�cx�F�F 9c�k 3c*dc 9c 9cn4c�c*dc�c�:�c 4t�c 9c 9c 9rxxr'cxx4cxic�'c is is 9rxic icxic is�e is 9c�c*�'c*�c :rc 9c 4cx*�cxic <br /> Supervisor/Lead Senior Comments: <br /> �.liK2 <br /> Z- <br /> ` 03- <br /> -41 <br /> J j - - <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECKOFF LIST. Proofread report? Correct LAND USE#? <br /> L If 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />