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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) M%KE COPIES FOR FILE <br /> LAND USE REPORT A P# S ft CSO _3 S <br /> N> - — -2 -S <br /> EHD RECEIVED APP.REFERRAL: / —'9-00 COMPLETE & SUBMIT B AS 14-IQ <br /> DATE DATE <br /> on� OJr' <br /> ATTN: <br /> SITE ADDRESS: <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 /> OF <br /> nn__ d/l. ;4 S "s 0 <br /> Qk <br /> eA <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> 8. aa; o L <br /> C . iS":61 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />