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NOTE: PULL ALL PERM�i'S (SEPTIC, WELL, ETC-) I�.kKE COPIES FOR FILE <br /> LAND USE REPORT APP# 51q-00 - 0 3 <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY 6 —D V <br /> DATE DATE <br /> ATTN: :r fhbi�//� <br /> SITE ADDRESS: rJ 3 <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: r Public sewage: <br /> SUMMARY OR COMMENTS: <br /> n <br /> —a <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 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />