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NOTE: 'PULL ALL PERMI`rS (SEEPTIC, WELL, ETC...) MSE COPIES FOR FILE <br /> LAND USE REPORT APP# O <br /> EHD RECEIVED APP.REFERRAL: ✓�� / COMPLETE & SUBMIT BY �� — U <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: J65? O 1 S P' C7 �g <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 /> -rPublic sewage: <br /> Public water: e:g <br /> SUMMARY OR COMMENTS: <br /> U <br /> 2,2:01 ✓ a � <br /> aw <br /> I recommend: Approval Denial Continuan _Inspector's Signature <br /> �Ir do�c�e***�c is ix*�E 9e�c do*9c$c 9c 9c 3e 9c 3c do�F:k9r*�c�c�'c 9c isx�'c is�c�F*�"c�"cxxxdc*�c do�c�c�Y is�c dr�F�'c*F�Tc'3t'°k*obde,4t:i'c 9e�'ca'c 9c�c�e do icxic a'c�c�c*�Y�c 7c is do aF pie de 9e�c <br /> Supervisor/Lead Senior Comments: <br /> ff+ r <br /> ? � <br /> D �i : d3 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECKOFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1199 <br /> Correct CONDITION(S)? Logged in LAND USE BOOK? <br />