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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAn E COPIES FOR FILE <br /> LAND USE REPORT <br /> EHD RECEIVED APP.REFERRAL:� COMPLETE & SUBMIT BY <br /> DATE n DATE <br /> ATTN: �P�,n I�A II aj <br /> SITE ADDRESS: 11 ,) n G2) f L ell G/ y , <br /> In completing the Land Use investigation, draw all Public Health factors on t e 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 /> oy <br /> 2;0 3 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> .O <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA If CHECK OFF LIST: _proofread report? _Correct LAND USE#? <br /> GH 06 06 Rev 1/99 <br /> Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />