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X fA <br /> NOTE: PULL ALL PERMS (SEPTIC, WELL, ETC...} KE COPIES FOR FILE I <br /> n <br /> LAND USE REPORT APP# m S- of <br /> EHD RECEIVED APP.REFERRAL: S- a- J()' COMPLETE & SUBMIT BY 6 - 6 - 01 <br /> DATE �} { DATE <br /> ATTN: <br /> SITE ADDRESS: <br /> 114-NO o <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: �� Public sewage: <br /> SUMMARY OR COMMENTS: <br /> z <br /> I recommend: Approval Denial Continuance Inspector's Signatur<L-,&kz�&..r-j <br /> Supervisor/Lead Senior omments: <br /> 2e)- : 0 �L <br /> e n : QS p','t" <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II,CIIECIf OFF LIST ' Proofread report? Correct LAND.USE#? <br /> EH 06 06 Rev 1/99 3 <br /> `� *Correct CONDITI0,1y(S)5 Lagged in LANDUSE BOOK? :` <br />