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sS <br /> NOTE: PULL ALL PEM. TS (SEPTIC, WELL, ETC-) 11 EKE COPIES FOR FILE <br /> LAND USE REPORT APP# j A- -0 1 -S6 <br /> 1 EHD RECEIVED APP.REFERRAL: S JV-01 COMPLETE & SUBMIT BY I <br /> DATE DATE <br /> ATTN-. ; p, <br />� as <br /> SITE ADDRESS: s�--- <br /> f <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 reap 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 Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OAS 1`1(WEeK ;Froofread report? CorrectLAND.DISE ? <br /> ' correct CONDITION S La ed,in LAND USE BOOK? <br /> EH 06 06 Rev 1199 ' � � {-�'.: g <br />