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-NOTE: PULL ALL PERMD-3 (SEPTIC, WELL, ETC—) M - E COPIES FOR FILE <br /> LAND USE REPORT APP# --O a43? <br /> EHD RECEIVED APP.REFERRAL: O' I 0,a COMPLETE & SUBMIT BY ; SS'J�-ab r <br /> DATE , v DATE <br /> ATTN: <br /> SITE ADDRESS: 2 j <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 /> ******dcic�r�r4e�rFa'e*k�ex�t*�c*****�r�kk�cieicir�c�r*�r�rk*deka's�c�t�t�tr�c**�kk�F9r�rde*�F';�r3c9r�t�r�cc9c*a'c9c**aEt*ic***ic*ic�cicicicisic*ic <br /> Supervisor/Lead Senior Comments: <br /> /4117 <br /> L 11 <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHEC,If OFF LAST =Praofrend report Correct LttND IISE#?. <br /> EH 06 06 Rev 1/99 � Cgrrect OONDITIQN(S) Logged in L4ND USE BOOK? �,�. <br />