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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# 03 <br /> EHD RECEIVED.APP.REFERRAL: % i COMPLETE & SUBMIT BY <br /> DAT DATE <br /> ATTN: 11; S� (. .J�ilnClFS <br /> SITE ADDRESS: <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 /> �-_ Vic. � :,..F.�;/ o+-t �� cr•.v.:�G'g — <br /> —c., r �.ct7So �s�a-y2. �,c1(�r.•��- G.ri��o.�,� <br /> v <br /> � recommend: Approval Denial Continuance Inspector's Signature <br /> xxx,xxxxx*x��x*x��n*x�xxx+*Kxxxxx*x�xx*x*xxx*��,�*x****xxxKxxxFxKxxxFxxxx��**xx7;x*xxx <br /> Supervisor/Lead Senior Comments: <br /> s b <br /> �� '1.� �.,✓1aJ OYt �'.�- x'_:✓s.''�rw ,s".0 c�G ;;�atLC��� <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> O 1 /I CHECK OFF LIST: _Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />