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* Ss <br /> NOTE: PULL ALL PERM S (SEPTIC, WELL, ETC... KE COPIES FOR FILE <br /> LAND USE REPORT APP# P-0 1 <br /> EHD RECEIVED APP.REFERRAL: ! COMPLETE & SUBMIT BY —0 <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: -7 c( r G <br /> In completing the Land Use investigation, draw all Public Health factors on the exhi it(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 /> Ar <br /> I recommend: Approval Denial Continuance Inspector's Signature <' + . <br /> 9c�r*ix 9e�t�e*fir it ie$c�c*ie�c is 9e�r*��c 9cic is�ix�c ie sir*�c�xxic*�c nF is�ex9t�c 9c�c�e is�c�exie��c��c is*�c dt�cxie 9cx�Ie�c�Y 3c*�F ie 9cxic�e�f�*�rxic iexzic ieXiex <br /> r- <br /> Supervisor/Lead Senior Comments: <br /> 16. <br /> 14, <br /> 44 <br /> ,oma <br /> S PERVISOR/LEAD SENIOR APPROVAL: <br /> C 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 /> ao�z� ,� � <br />