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NOTE: PULL ALL PERMItS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: a _02 COMPLETE & SUBMIT BY <br /> DATE / ^ DATE <br /> ATTN: J n n 1 4 3o I I S / <br /> SITE ADDRESS: I R, () 7 �f , e /'1 �-{l ty o e S �� <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: VP Public sewage: <br /> - <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval`/ Denial Continuance Inspector's Signature' r <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECKOFF LIST: Proofread report? Correct LAND USE#? <br /> EF1 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />