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♦ /) � <br /> MOTE: PULL ALL PERM* (SEPTIC, WELL, ETC...) Mhj{E COPIES FOR FILE <br /> LAND USE REPORT APP# - �x <br /> EHD RECEIVED APP.REFERRAL:-LL)-15-00 COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN• j;M VIAn &ret i <br /> SITE ADDRESS: )() Ig A , 141 D;11, (e d , , Sr�n C,&A-, <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 /> �c�'e*ie 9c is is�E is is is oc�c�'cxic is 4c*i'ca'c�e is 3c it icx�c*�c�c�c�c�F icx�'r ie ie�c is is is is�c it is�'c�c is is*rc�c*ic is 4c i��F is is is�F is is 9e�c�c�F is�Y�F�c�F is it�c 3c�'c�c 9c ye is is is ie�c is 9c <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />