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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) N1riKE COPIES FOR FILE <br /> LAND USE REPORT APP# Sig) <br /> EHD RECEIVED APP.REFERRAL: v 1 COMPLETE & SUBMIT BY g 3 <br /> DA � 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 Signatu <br /> de is*�'e ie�c ie is�'e ie is�c�'t 9c 9e 9e dexie�c is�c 9c�'c�c�'eie*�c ix icXxie�e is ie is ie ie is ie is ie is is is�c�c ie�'c is�c ie�c�ex�F it ie is is�c is is*xic ie�c�c ie is is iei iexic ie 9c is ix ie it�c�e hex <br /> Supervisor/Lead Senior Comments: <br /> � Y <br /> A- /4 ' 0 <br /> • as- <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> LAND USE LOG _j a/ OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> Eft 06, ON CALENDAR �/ Correct CONDITION(S)? Logged in LAND USE BOOK? <br />