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r <br /> NQ,TE: PULL ALL PERMS (SEPTIC, WELL ETC...) NrHKE COPIES FOR FILE <br /> LAND USE REPORT APP V: -) <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT By �qs <br /> �-p <br /> DATE r <br /> DATE <br /> ATTN: <br /> SITE ADDRESS 1 Q ID y <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 /> r <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �r�k$xnF�e9e�F�r�e�Ir�eoE�kdr��ir�E�EnF�rvkelr�rvF**%F�Y�c*�e:F�k�rnF*�cFe�r�'ex:EnF�Ir*.�rx:EvE�eir�e�e�trie�firele�e�k�$c�cir3r�lr*�r�r�t�eiF9r�te ic9rie�e�c�'riei�e' 9e�� <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA'II CHECK OFF LIST � ;, Proofread ieport? � "Correct L,4ND'TISE#? <br /> EH 06 06 Rev 1/99 ' y>Corre`c!CONDl7I01V S}$ ed'i►r LAND USE s <br /> • l F <br />