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/NOTE:-' <br /> PULL <br /> ALL PERMS {SEPTIC, WELL, ETC...) M COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> ;_ rC� COMPLETE & SUBMIT 13 <br /> EIID RECEIVED APP.REFERPULL: HATE <br /> DATE n r <br /> ATTN: <br /> SITE ADDRESS: g <br /> In completing the Land Use investigation, draw all Public Health factors s�wage�d <br /> o eThd draw completed map of area <br /> exhi it (i.e-: sewage sal, <br /> I p g <br /> water supplies, etc...). Where necessary, on an attached piece of plain paper, <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 Se�n.ior Comments: <br /> old <br /> Q � <br /> 3 - <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> s4A'11 CHECK OFF LIST' E:Proofread report? } Correct L�9IYD�USE# <br /> n Ld ed'in`LAND USE'BOOK? ,. <br /> CorreclCOND1TIflIVIS .. g� 3.. <br /> El f 06 06 Rev 1199 <br />