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I Ir <br /> NOTE: PULL ALL PERNIITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED.SPP.REFERRAL:. 'P 00 COMPLETE & SUBMIT BY i- J 1 o_,5 <br /> DA7E I DATE ^T^ <br /> ATTN: _ eser <br /> SITEADDRESS: ^ e M U <br /> In completing the Land Use investigation, draw all Pu lic 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 /> prn <br /> Public water: V�r Public sewage: <br /> SUMMARY OR COMMENTS: <br /> on <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> StiPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: !/Proofread.report?" 1,--`Correct LAND:USE#? <br /> LH 06 06 Rcv 1/99 _ Correct CONDITIONS)? �Logged.iit L.1ND USE BOOK? <br />