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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) 1V1,tKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: 0103/b3 COMPLETE & SUBMIT BY 7 Z <br /> DAT D; E <br /> ATTN: C <br /> SITE ADDRESS: a 6 <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibiti.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: 44J Public sewage: <br /> SUMMARY OR COMMENTS: <br /> ZL- o Z <br /> Irecommend: Approval <br /> Denial Continuance Inspector's Signature <br /> ,t�,tcxie,��F�e�icieir*dc�'c9c�c�ca'ea'C**�C�x����*iex�Yieic:F�e4c�eie*i�xic�e�c**�Cie�c�eicx*�e9cicic�ciririeicieieie�Fxieierr9exxic��cic4cicicie9cix�cicicicxicic <br /> Supervisor/Lead Senior Comments: <br /> -r s'Tt <br /> ;JJcct C <br /> v <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EF{06 06 Rev I/99 <br /> Correct CONDITION(S)? Logged in LAND USE BOOK? <br />