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1 •�� <br /> '• PERM SEPTIC WELL ETC... N E COPIES FOR FIL <br /> NO'T'E. PULL ALL ( , } <br /> J <br /> LAND USE REPORT APP# - O <br /> EHD RECEIVED APP.REFERRAL: — COMPLETE & SUBMIT BY — 16 —03' <br /> DATE112.A � <br /> DATE <br /> ATTN: (� <br /> SITE ADDRESS: <br /> In completing the Land Use investigation, draw all Public ealth factors on the exhibit (i.e.: sewage disposa; <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 /> 7 Q 2.. A 3a . <br /> n <br /> I recommend: Approval Denial Continuance Inspector'.s Signature <br /> Supervisor/Lead Senior Comments: <br /> - I <br /> �p <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H.CHECK LLST <br /> OFF :Proofread Erepnrt 9 k Correct T rlND USE S <br /> E}!os o6 Rev us9 $ " E Correct CONDITI0IV(SJ?g ' Logged rn Lf1NI1 DISE BOOM <br /> 6p6p <br /> �1 <br />