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COPIES FOR FILE <br /> 'NOTE: PULL ALL PERMS (SEPTIC, WELL, ETC...} M� <br /> ' LAND USE REPORT APP# � 3 <br /> EHD RECEIVED APP.REFERRAL: J:_,96—C) / COMPLETE & SUBMIT BY 2 - DATE <br /> A E <br /> DATE <br /> ATTN: <br /> SITE ADDRESS: C) <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 <br /> Supervisor/Lead Senior Comments: <br /> Oq <br /> 4 <br /> a <br /> �a-•. a 3. �t <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> ==AKOFFLIST Prov rears re ort? Correct LAND USE#9 <br /> f P <br /> �Correct COIVDIT10tY(SJ9 `�'Loggerl cn LAND iISE�DOX� <br /> EH 06 06 Rev 1/99 <br /> �� - <br />