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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) 1V AKE COPIES FOR FILE <br /> LAND USE REPORT APP# " <br /> 03 - 3 � �� p1 : <br /> EHD RECEIVED APP.REFERRAL: �� COMPLETE & SUBMIT BY 7 D n /�r� <br /> DATE DATE T <br /> ATTN: Lie anne Mt)� <br /> SITE ADDRESS: q,-3 6 nAl . D <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 /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Commments: <br /> V <br /> SUPERVISOWLEAD SENIOR APPROVAL: <br /> Y <br /> OA II CHECK OFF LIST: _proofread report? Correct <br /> AN BOOK? <br /> EH 06(M Rev uv9 Correct CONDITION(S)? Logged <br />