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NOTE: PULL ALL PERM -fS (SEPTIC, WELL, ETC...) NIKE COPIES FOR FILE <br /> LAND USE REPORT APP# .5(q -00 - <br /> EHD RECEIVED APP.REFERRAL: '�I 00 COMPLETE & SUBMIT BY / 9-®0 <br /> DATE DATE <br /> ATTN: je.v� i JO j I t-t,, <br /> SITE ADDRESS: <br /> In completing the Land Use investigation, draw all Public Hea th 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 <br /> it is�F isxrcxxic�c it 9c�c 4c 4c ix�c�cX�Fx4c 9c 9c�F it�c�r�c ycXx4c�cx4c�'cx3c ae�F is 9c 4c is�cx�cx�'ca'c�c�c�'c�c 9cx�c is 9c�c 9c�F*X*�c�E it sc�c�c*�'c�c ac�c�E is 9c�c ac is�Y is dcxzxic <br /> Supervisor/Lead Senior Comments: <br /> 0 / 4-.-, �-".-0 Z <br /> A <br /> • <br /> r �I - <br /> C. <br /> SUPERVISOR/LEAD SENIOR APPROVAL: G <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 />