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A . � <br /> NOTE: PULL ALL PERM t'S (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# j S - I q - ! L7"67) <br /> EHD RECEIVED APP.REFERRAL: ✓ �� `<—� COMPLETE & SUBMIT BY �� /C/ -03 <br /> DATE DATE <br /> ATTN: <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: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �'e9cx*9c�cxFFzxxx�ex�cx*oex�c�c*�ricexxic�c9cxxicicic�cicxxxicicicicxirie<icic�r�cicFxicicieieicxx�cxiricicicxxicxxxxie�cx�cxxx9c�cicxE�cie <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST.• Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITIONS)? Logged in LAND USE BOOK? <br />