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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) NuAKE COPIES FOR FILE <br /> 5Q-Oct - 3; <br /> LAND USE REPORT APP# Y-yo-I , <br /> EHD RECEIVED APP.REFERRAL: .�8'�CO COMPLETE & SUBMIT BY <br /> DATE <br /> ,,�1 I DATE <br /> ATTN: 9 o I , G� I-Chr o Ck <br /> SITE ADDRESS: <br /> In completing the Land Use investigation, draw all Public Health factors on the e ibit (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 /> Supervisor/Lead Senior Comments: <br /> 4 <br /> 0 : 4 �i�-due- � � t � �`'►~-r'� <br /> it <br /> rr <br /> SUPERVISOR/LEAD SENIOR APPROVAL: 41t, �. <br /> OA H CHECK OFF LIST. Proofread report? Correct LAND USE V <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />