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--rtj <br /> N,7TEc' PULL ALL PERM,.S (SEPTIC, WELL, ETC... 1KE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: q —tO —0 COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: � 3 o 3 1= t"'ye_ On (c e o(. <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 /> / 4 ,2 C r <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECKOFF LIST.• Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 11 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />