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NOTE: PULL ALL PERNMS (SEPTIC, WELL, ETC...) NrAKE COPIES FOR FILE <br /> Pr-e - <br /> LAND <br /> -LAND USE REPORT APP# i� ��s <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY —3 <br /> DAVE DATE <br /> ATTN: je / - <br /> SITE ADDRESS: (2.K ,Lk ALI <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 A 'Xe <br /> is icxxx7cxxxicx icxicxic>cx is is�c�cx�'cx is icxicxic is r.i�ic is�c ic>c icxicxic icxicz r.i:xxxxxxxx�c is 7c irx icx9c is ycxyc x�c*fit 9c 4c xxxicxic it is is is is icxic <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />