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LG <br /> NOTE: PULL ALL PERNMYS (SEPTIC, WELL, ETC...) NTAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL:D-S 03 COMPLETE & SUBMIT BY—L/ NI 03 <br /> ATTN: tTM D 1 <br /> SITE ADDRESS: a Q3XLTtn� -nra e 2-p OG`' d f <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 /> - 3 E <br /> _� <br /> I recommend: Approval Denial Continuance Inspector's Sign <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 _Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />