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NOTE: PULL ALL PERMI its (SEPTIC, WELL, ETC...) M"TKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: /0-a -D'o C MPLETE & SUBMIT BY 00 <br /> DATE �/ DATE <br /> ATTN: G�'Y► �lJ U <br /> SITE ADDRESS: 7 S, Z <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 /> �9- 0 <br /> r . . <br /> j ( .017 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> t <br /> !?;e�Ze�e4 <br /> I (/ <br /> w <br /> C ii :03 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />