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i <br /> `NOTE: PULL ALL PERMITY S (SEPTIC, WELL, ETC...) Mt,,KE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> I <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY <br /> DATE DATE <br /> €� ATTN• -r �. <br /> SITE ADDRESS: <br /> u <br /> In completing the Land Use investigation, draw all Public Health factors on the exhl 1t G.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 /> E� <br /> �5 <br /> I� <br /> f� <br /> k <br /> f li <br /> I recommend: Approval Dania! Continuance Inspector's Signature <br /> It <br /> Ef I .Jt <br /> Supervisor/Lead Senior Comments: <br /> .e <br /> {d <br /> I <br /> a <br /> fi <br /> it <br /> II � <br /> f r <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> E� <br /> ,� a°QA II CHEC1�OF ST � Proo,fraud'report�,� " �Gorrec�SAND USE#��� <br /> EH 06 06 Rev 1199 <br /> Correct CONDITI4N(S}? Loggedrn 'LAND USEBOOK� <br /> ,;IS7, ..,fl`x,Pw.L� <br />