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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC—) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP <br /> EHD RECEIVED APP.REFERRAL: 1l 3'0/'l 9 COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: 1 n o. 101 ng Y- s Ze� <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 /> D 3 <br /> a <br /> I recommend: Approval ✓ Denial Continuance Inspector's Signature <br /> �cx�kicx�c�cicxia�iic�kxic9cic�F�'c�e�c�c*deX�'cxdc�Fx�cic�'c�c�c�4ir�c9c�Y*�c*i'c�c�F�c�c�E�c�e�c*�c�E�'c*�'cie*�c�cic�cx*�Y�c*�'c�'cic�F�c�cic c�c�c3e�cxicic�'ek�Fx�F <br /> Supervisor[Lead Senior Comments: <br /> b� <br /> 22 rs� <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <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 />