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NOTE: PULL ALL PERMITS SEPTIC, WELL, ETC... Nk,-vKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: /J-9 -q7 <br /> COMPLETE & SUBMIT BY '19 <br /> DATE / DATE <br /> ATTN: r1 /7 <br /> SITE ADDRESS: y C7 <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 /> 4c�c*4cxa'c�c�cx�c�c$c�4c it 9c�c**�c�"e*k�c�c k'c�c 9cxdc 4c�c*�c�c ie 9c�c is is�e�a'cx�c 9c�c'c**E�c 9e 9c F is 9c ie�c�e 9c is isxxis is is F vkxir is Y ie ix is�c'c c�l� is�'ex�c�"e*ic <br /> Supervisor/Lead Senior Comments: (/ <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> Eli 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />