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a Vy <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: O- - COMPLETE & SUBMIT BY 7 - 6 <br /> — <br /> DATE DATE <br /> ATTN: To (rU I7,t,CCi <br /> 1n <br /> SITE ADDRESS: a H K <br /> In completing the Land Use investigation, draw all Public Health factors on the exh' it(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 /> i1:0 (, <br /> 22 ;� y <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> � 4- <br /> a l <br /> ZZ- o <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />