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NOTE: . PULL ALL PERMITS (SEPTIC, WELL, ETC...) M-rr [E COPIES FOR FILE <br /> LAND USE REPORT APP# SA-- ©1 7- <br /> EHD RECEIVED APP.REFERRAL:-1 COMPLETE & SUBMIT BY /O /J <br /> DA �� DATE <br /> ATTN: <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 /> Supervisor/Lead Senior Comments: <br /> SUPERVISOWLEAD SENIOR APPROVAL: <br /> OA I/CHECK OFF LIST: _Proofread report? Correct LAND USE#? <br /> Correct CONDITION(S)? _Logged in LAND USE BOOK? <br /> EH 06 06 Rev 1/99 <br />