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NOTE. PULL ALL PERMITS (SEPTIC, WELL, ETC...) Nr iKE COPIES FOR FILE <br /> • <br /> APP# P o//nn <br /> LAND USE REPORT r`'r 3 <br /> COMPLETE & SUBMIT BY <br /> EHD RECEIVED APP.REFERRAL: I` �l DATIE <br /> DAT <br /> ATTN• HLA n ► ,u 1 P,� l <br /> • N SITE ADDRESS:ADDRESS: 6 <br /> LA 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 <br /> dee prion,iece (plain paper, draw completed map of area <br /> showing population density, location of house, ` <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> I recommend: App <br /> royal Denial Continuance Inspector's Signature <br /> �cx*3e�'c�'e 9c�c�cx is is�c is is�c�c�cx�c�k hex ix i�ic iexic�c ye x�c�c�cxx Xic itxir is is is is is is i�icx�c�'c is it ie�cxx�c ie�'e�e iexic�e r'c�'c is�e�c�c�ex9c�Y 7e*dc�r isx�e is ie�c is icz <br /> Supervisor/Lead S nior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? Correctin LAND USE BOOK? <br /> Correct CONDITION(S). Logged <br /> El 1 06 06 Rev 1/99 <br />