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SEPTIC WELL ETC... MAKE COPIES FOR FILE <br /> NOTE: PULL ALL PERMI ( ) <br /> LAND USE REPORT APP# U P - 00 - /9 <br /> EHD RECEIVED APP.REFERRAL: oZ i)0 COMPLETE & SUBMIT BY —/ _ 0() <br /> DATIZ / / DATE <br /> ATTN: l:�ACt�/l �l - <br /> SITE ADDRESS: -� Z o 1 zr— V ie S —/0C k;6W <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: ,(/p, Public sewage: <br /> SUMMARY OR COMMENTS: <br /> •� <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �c�e*xX�c�c 3c�c is*�c�c�c it 9c 4c�c**x'c�c�t�c*E�c icXicxic�c 9cx�c�c is dr�c is is�c�cx�c�c*F do 9e is is is is icx*ic is iczxic is F�c�c"c*3c*9c�e�e 9c do�e icX�cx�c* �e 4�"c 9e\ <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> E <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />