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NOT' : PULL ALL PERMI'T`S SEPTIC, WELL, ETC... AIKE COPIES FOR FILE <br /> LAND USE REPORT APP# `�IF-i -(�/-5 <br /> EHD RECEIVED APP.REFERRAL: / V 10-�,— COMPLETE & SUBMIT BY 44, —// <br /> DATE ATE <br /> ATTN: ./lMl �'l <br /> SITE ADDRESS: 1 :3 6 y 5 a2 j� <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 /> 9c�c iaxicxic icxic icx�c�cxxx�cxx�cxF is isx�c�xiexicxxi4x�c it ie 9exie�'c�$c�c�iex�c it'c*9c ie ie it is�e ie�e is�cxxie�e�ek��r ie it ie is:F icxxxxxicxic ie icxacx <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 />