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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC-) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# - 3 �- <br /> �`l�� !)^ COMPLETE & SUBMIT BY i` f <br /> EHD RECEIVED APP.REFERRAL: DATE <br /> D E <br /> ATTN: <br /> SITE ADDRESS: In -:Z <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 <br /> :� <br /> Supervisor/Lead Senior Comments: p, k <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK©F�'LIST: �k�� ..'�` Proofread report?�'"'�� C�rrect LA1vD CTSE#? <br /> ► Correct CONDITIONS) x NVk BgrIISOOKg <br /> Eli 06 06 Rev 1199 <br />