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A-G <br /> NOTE: PULL ALL PERMS (SEPTIC, WELL, ETC...) ME COPIES FOR FILE <br /> LAND USE REPORT APP# Q 3 <br /> ESD RECEIVED APP.REFERRAL: 1_196-0 / COMPLETE & SUBMIT BY ` DATE <br /> DATE <br /> ATTN: <br /> SITE ADDRESS: C� <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 /> *ek*******fir*9ca�r�'eke*i'c*ice'eFle***4eelyde�e:h�t�elriFFa�t�r�e�c**3e�e�e*aF�ealeixx**$c>e*aFdcirE*ie�exie3c*�r�edr�c*�e4rde�eii*9t�edc9ckie9ede**�e�edc <br /> Supervisor/Lead Senior Comments: <br /> "> <br /> ' q .2 <br /> 40 <br /> if V <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> EE <br /> II CHECK OFF LIST s Proofread reports Correct LAND IISE#? <br /> Lagged rn LA1VD USE BOOK <br /> Correct COIYDITIDN(S) 6 <br /> EH 06 06 Rev 1199 <br />