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NO'S'E,: PI ILL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# -5 A "lam -aT <br /> EHD RECEIVED APP.REFERRAL: 6 —/3-00- COMPLETE & SUBMIT BY 7 - 3 --<D <br /> DATE DATE <br /> ATTN: `r( n <br /> SITE ADDRESS: of ab9b E7I S+`rd ` —.'rlj_t --- <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 /> I recommend: Approval Denial Continuance Inspector's Signature�T—J �. <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> \ EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />