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NCTE: PULL ALL PERM,..S (SEPTIC, WELL, ETC...) 1�,.,.KE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: _!�— q COMPLETE & SUBMIT BY 6 ` O� <br /> DATE - DATE <br /> ATTN: T—r (1 ti Ile C <br /> SITE ADDRESS: <br /> In completing the Land Use investigation, draw all P blic 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 /> �2- 1, 0a <br /> 1! • �� <br /> ;2-y1 <br /> I recommend: Approval Denial Continuance Inspector's Signatur <br /> Supervisor/Lead Senior Comments: <br /> I �— <br /> �C <br /> SUPERVISOR/LEAD 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 />