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NOTE: PULL ALL PERNTI'S (SEPTIC, WELL, ETC...) XTAKE COPIES FOR FILE <br /> LAND USE REPORT APP# 5A-01-01( <br /> EHD RECEIVED APP.REFERRAL: �—3-01 COMPLETE & SUBMIT BY —( ,? —V <br /> DATE J DATE <br /> ATTN: , / C �S k-lz <br /> SITE ADDRESS: I I q &7 a N �— '?1 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: <br /> SUMMARY OR COMMENTS: <br /> z 7- �% r L2 <br /> v <br /> i <br /> Ej <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �rkFix�eE�e�e�c�cx�c�rFFk9c4e'eF�c�c�c**ic�c�c��EEE*�ex�r�cic*icic3c*nE�Ficdc3cic9c�c'c�cir�r*9c*9c 9c**��c�cic�cYF�c9cicic�c*9c9c�c'c�cicicicie*:civic <br /> Supervisor/Lead Senior Comments: <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 />