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1 <br /> �NOTI�: PULL ALL PERMI"I'S (SEPTIC, WELL, ETC...) IviAKE COPIES FOR FILE <br /> LAND USE REPORT APP# -5 a -o <br /> EHD RECEIVED APP.REFERRAL: -c2q-Ot COMPLETE & SUBMIT BY --/,3 <br /> DATE DATE <br /> ATTN: 2 r <br /> SITE ADDRESS: <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: G-!Public sewage: <br /> SUMMARY OR COMMA TS: kJa rA--�S -.At-' Z Weal - C <br /> I recommend: Approval Denial Continuance Inspector's Signature '� d4--, <br /> �ir�'t�cic$Tiede*�Ficic�c�e�c9e�eicde�e�F�e�e9c�e9e�e�c�Irx�e�e�c�r�rxx�rx�Ic�c�cx�r:F�c�c�cir�c�c9e�c9r�c9r�e9crc3c�cicreieie�F�c�exxx9coYnFie�c�cicx�c$exic�exxxiexx <br /> Supervisor/Lead Senior Comments: <br /> 0 / <br /> p V <br /> P 9X <br /> IQ <br /> VV <br /> I <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST.• Proofread report? : Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />