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JTE: PULL ALL PEWMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: V— VI ' COMPLETE & SUBMIT BY__ ('� — q <br /> DATE DATE <br /> ATTN: <br /> T la e r p4g, .S e r <br /> SITE ADDRESS: 0o A f k In <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 /> . O 2 <br /> o <br /> 1 recommend: Approval Denial Continuance Inspector's Signatures <br /> Supervisor/Lead Senior Comments: <br /> oo::f <br /> L11 Oar- <br /> SUPERVISORILEAD SENIOR APPROVAL: AA <br /> OA Il CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EF106 06 Rev 1199 i �.% Correct CONDITION(S)? Logged in LAND USE BOOK? <br />