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&QTF: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: .-) -3/--0(-) COMPLETE & SUBMIT BYyDATEa v <br /> DATE <br /> ATTN: <br /> SITE ADDRESS: _/,2 6 <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: 1e D`r�✓ /U � ' �' Y <br /> SUMMARY OR COMMENTS: #e is I �� � �I P <br /> - <br /> ti" o <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> � b <br /> S- <br /> �aaaly��IrPI )_*;4 " <br /> ; 1ifa <br /> 'Nc <br /> D6�- of oLa,-4Mbs <br /> SUPERVI OR LEAD �PPROVAL: <br /> p�t1 OA H CHECK OFF LIST.- Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1199 11 <br /> Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />