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1 <br /> NOTE: PULL ALL PERMI 6 (SEPTIC, WELL, ETC...) M;' E COPIES FOR FILE <br /> S4 <br /> LAND USE REPORT APP# `� 7 <br /> EHD RECEIVED APP.REFERRAL: �O� � Wad COMPLETE & SUBMIT B <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: 62 _ ' <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 O OMMENTS• y <br /> a <br /> r <br />' I recommend: Approval Denial Continuance Inspector's Signatu <br /> i Supervisor/Lead Senior Comments: <br />.j <br /> i <br /> i <br /> I, <br />'I <br /> I <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> it OA II CHECK OFFLISTPrvvfrearl report?` _ =��`Correct.LAND USE#9 <br />' £H 06 06 Rev 1199 <br /> u r;r-0 �Cottee!CONDITI(SN(S), °_ - Lagged!n LAND USE BOOK? <br />, <br />