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H 1 <br /> NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) N. AKE COPIES FOR FILE <br /> LAND USE REPORT APP# S -bY* <br /> (� COMPLETE & SUBMIT BY <br /> EHD RECEIVED APP.REFERRAL:DA DATE <br /> ATTN: dv►v►^Q ,l I �P,,� <br /> SITE ADDRESS: <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 /> *xxic is�c ycxx'e irxicx9r 'c is is ie*ic�c kic�CXXX)C is is icxicx is icx sc is iexdc iexxF is F is is is is is ie isx is is is is is cx�c isxdox9c it 9c�c ie x9c iC 9c�t 9exie'itxicxiexx <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 I/99 <br /> Correct CONDITION(S)? Logged in LAND USE BOOK? <br />