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J <br /> NOTE: PULL ALL PERNMS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP#�5'/4 <br /> EHD RECEIVED APP.REFERRAL: I a-1 COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: I jle <br /> SITE ADDRESS: aUID/ A] ' P rrc- <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.... �c <br /> / � 7 <br /> Public water:. L — y� ublic�ewage: d�, o O y <br /> SUMMARY (�It O1�Vlr1VYENT ; ' S`1 ,r� �! S P r' �' P 5% 'Yl e-t' <br /> !., <br /> r <br /> I recommend: Approval_IZ"Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD 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 />