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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP _# �)P„ 9q <br /> i <br /> EHD RECEIVED APP.REFERRAL: S —3 —gq COMPLETE & SUBMIT BY 5 — // <br /> DATE ll r ELATE <br /> j ATTN: `� cJ t: P+ F;S�e..E <br /> srTE ADDREss• _)q -7q q Al , ±1,j.n rn4r <br /> In completing �he 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: Ili o nu- Public sewage: L� <br /> VIII <br /> SUMMARY QR COMMENTS: <br /> II� <br /> d <br /> �C <br /> �H <br /> �C <br /> 1� <br /> I ' <br /> JIB <br /> I recommend:, Approval Denial Continuance Inspector's Signature <br /> Spervisor/Lead Senior Comments: <br /> I <br /> y r <br /> 4 <br /> �I <br /> 9P <br /> I <br /> .I. <br /> SUPERVISO iIR/LEAD SENIOR APPROVAL: <br /> OA 11 CHECKPfT LIST. V Proofread report?`- , Correct LAND USE#?, <br /> FH 06 06 Rev 1199 ,Correct CONDMON(S)? -Logged in LAND USE BOOR? . <br />