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NOTE: PULL ALL PERMrTS (SEPTIC, WELL, ETC...) M7tKE COPIES FOR FILE <br /> LAND USE REPORT APP# — ,A <br /> EHD RECEIVED APP.REFERRAL: 'dU COMPLETE & SUBMIT BY .5 - <br /> DATE DATE <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 density, location of house, wind direction, etc.... <br /> Public water: C Public sewage: G %J` [� >e / G t a; ; <br /> SUMMARY OR COMMENTS: <br /> Awl <br /> 7 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> © y <br /> �. II : oa. <br /> C. Jz o <br /> SUPERVISORILEAD SENIOR APPROVAL: j M — <br /> 11 CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged In [.n ND cJsF� 110"Kz <br /> EH 06 06 Rev 1199 <br />