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I - 96 <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) 1V1AKE COPIES FOR FILE <br /> LAND USE REPORT APP / �Sr4 <br /> EHD RECEIVED APP.REFERRAL: —OZ, 0 COMPLETE & SUBMIT BY y- 0/ <br /> DATE DATE <br /> ATTN: It 0 <br /> SITE ADDRESS: <br /> In completing the Land Use investigation, draw all Public Health fact rs 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 /> 9exxirxis rr is isx icxx*x9c is�e$ek�e�'c�"e�ex�'e de�c�t a'e�c�e�'e 9c�e�'e iexie�ex�rxde�'c�c*�c�'e*x9c ie�F is 9ex�c�'c it�'c ac is isxic�t�Y�'ex9ex�k is�Y*9exiexisxXx�exiexie�ic <br /> Supervisor/Lead Senior Comments: <br /> E <br /> AJ <br /> O-A 601 <br /> ` w <br /> VV � /Vf•f_/+_ <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE BOOK? <br /> 1:1106 06 Rev I/99 <br />