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WELL MVKE COPIES FOR FILE r� <br /> NOTE: PULL ALL PERMS (SEPTIC, � ETC...) <br /> LAND <br /> USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: I —1 0-3 COMPLETE & SUBMIT BY OD <br /> A <br /> DA) / <br /> ATTN: <br /> SITE ADDRESS: 3q p <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 /> <3�1s<�o3 <br /> ep-141sicG � 5 � L l� � �i2�•ns�<,�s <br /> cJ" Luh�d f�� � 7�5 BELS�✓ <br /> I recommend: Approval <br /> Denial Continuance Inspector's Signatu <br /> 9c 4e*ic sr�c�e�'c ix�'r is�c�c�e�c�F ic*Jc do is ix�r�c 4c ak 9c 4c dcx ie 4e do 9c aF do*xxx�Y 9e 9e 3c�e�e�c 4e�c is is ie�F�c�e�exac is ix isxzic iex�F is�e ie�c�c ie ie re�c*�r�'c rr�e is�e ie�c***'3t is <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> 70A 11 CHECK OFF LIST: Proofread report? -Correct LAND USE <br /> Lo ed in LAND USE BOOK? <br /> Correct CONDITION(S). �'� <br /> Ft1 06 06 Rev Il99 <br />