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`NOTE: PULL ALL PERMI S (SEPTIC, WELL, ETC...) M'A�E COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: Jl )<2,3 -00 COMPLETE & SUBMIT BY E-00 <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: <br /> In completing the Land Use investigation, draw all Public Health factors 6/n"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 /> d <br /> 2b:o I <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> © '2 <br /> � DQ ! —2 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: P5 <br /> DA II CHECK OFF LIST - ,s "Proofread report? Correct LANG USE# <br /> EH 06 06 Rev 1/99 h' # " Correct CUIVDITIONS)9 Lagged to I�4ND USE BDOKT <br />