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x_ <br /> NOTE: PULL ALL PERNItt'S (SEPTIC, WELL, ETC...) N.,.KE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY <br /> *AE DAT <br /> ATTN: ll <br /> SITE ADDRESS: e� 3� �`� ��-� 0� <br /> In completing the Land Use investigation, draw all Public Health factors on the exhlbit.(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 /> " c <br /> 4 <br /> �— <br /> recommend: Approval Denial Continuance Inspector's Signature <br /> Ic + <br /> eis ie:<ic ieis icxxAppr >c is iex icx xxx x�cxie icxicx is is cis is icxxiex*xxsc�cX x>cr'cx�txye dex5ex4e a'e�"e 9e 3eX�e ki'e�Y-h ie icxxxic>c>c x%;icxxxic r.>: <br /> Supervisor/Lead Senior Comments: <br /> 0 <br /> IF <br /> .3/9"u <br /> J4 416 <br /> � O <br /> yz <br /> G <br /> erg <br /> .� - <br /> D ' SUP SENIOR APPROVAL: f <br /> ov� D <br /> , OA H CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> v�nU" u <br /> Ell 06 06 Rev 1/99 Correct CONDITION(S)? Logged b'ged in LAND USE BOOK? <br />