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NOTE: PULL ALL PERM S (SEPTIC, WELL, ETC...) 1V KE COPIES FOR FILE <br /> ``` A-e --o,.pp <br /> LAND USE REPORT APP# oa - 17( 6! - ) <br /> eHD xecerveD Are.REFERRAL: COMPLETE & SUBMIT BY J <br /> 6AW DATE <br /> ATTN: 1. 2 ti n U Jde <br /> SITE ADDRESS: 0 <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 /> oy <br /> ;:I • orb <br /> : a <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA Il CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />