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�c <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> l <br /> LAND USE REPORT APP# �('-0 0 -O? 4,21e-00 -2 <br /> EHD RECEIVED APP.REFERRAO -12 COMPLETE & SUBMIT BYy c�) dy <br /> DATEDATE <br /> ATTN: "q,GAt1A lnn' <br /> SITE ADDRESS: <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: -e-S <br /> SUMMARY OR COMMENTS: <br /> O • dq <br /> 1 <br /> :0 Z 7Lqj c6)1,1 Ci 471 Sz,-� ,f <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> *4c�cic9e�"c*k�c�e*x�cicic'cc�Cx�c9ck�c'c4F�c�c�'c9cF*�c*9c'c*x9cie*�c�e'c9c�cicic�c�cic�cicicXxa'cicicxa'cieX�cieicicicicF9c�Y*9e do c�'c�'c�'e*�cic9c�c�e'c9c�c�eF <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST.• Proofread report? U'f Correct LAND USE#? <br /> EH 06 06 Rev 1/99 , Correct CONDITION(S)? � Logged in LAND USE BOOK? <br />