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NOTE: PULL ALL PERMYTS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> 'm <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: O b COMPLETE & SUBMIT BY ATE` — 03 <br /> DATE <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 /> w <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> *4c�cir**sir*,F,�,t�*�cie*�r�*ir*9t*,p�,t�,k�F 9e 9cvF*4t�riciticie�e9e$r�kicrr�c�c�c�r9e*�e*�e9c�e�Yicicdcirieic�eicaFicx�eicie�c9c7cx�'c�cick*�cici�zicxicicxicieic <br /> Supervisor/Lead Senior Comments: <br /> r <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA H CHECKOFF LIST: Proofread report? Correct LAND USE#? <br /> Correct CONDITION(S)? Logged in LAND USE BOOK? <br /> Ell 06 06 Rev 1/99 <br />