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OTE: PUILL ALL PERM S (SEPTIC, WELL, ETC...) 1`'" KE COPIES FOR FILE <br /> LAND USE REPORT APP# — /'"�7 <br /> EHD RECEIVED APP.REFERRAL: q'I 'C)1 COMPLETE & SUBMIT BY 5 -- f�I <br /> DATE DATE <br /> ATTN: J _rte <br /> SITE ADDRESS: cg <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 <br /> ewage:SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> o • <br /> C a� • � r <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF Proofread report? x Corree!'LAND USE#9 <br /> EH 06 06 Rev 1199 Correct CONDITt011�(S) Logged fn LAND USE BOOK?. <br /> '� .rt<,--Ear <br />