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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MtiKE COPIES FOR FILE <br /> ` LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: Y' / —W COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: a5 ,)-Q [ <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 /> :0q <br /> 2,0, <br /> 0q2,0,v ( <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �r9e�+e*�Ir9edrdc�edede�c9e9r*�c�c9r�e9c�c9e*dc3e�+c�c�r�ex�k�e3r�E�ez�e�e*�c�c�cx�r�cir�cie�c�e9c�c�cie*ic**�e9c�cica'tier'c�Y�c9e�'c�e�c�c�ex*��c�c�F�c*�e�F*�e9e�"c9ede�'c <br /> Supervisor/Lead Senior Comments: <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 />