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�yo <br /> NOTE: PULL ALL PERTM TS (SEPTIC, WELL, ETC...) Mil!WE COPIES FOR FILE <br /> LAND USE REPORT APP# )',/� -a3- Is' <br /> EHD RECEIVED APP.REFERRAL: O COMPLETE & SUBMIT BY YzL-�O/V 3 <br /> DATE I / I DATE <br /> ATTN: j j0Nj n 1 k 1- <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 /> 2 ,L <br /> I recommend: Approval Denial Continuance Inspector's Signature } <br /> Supervisor/Lead Senior Comments: <br /> CAIits _ 0.1- ! e <br /> V <br /> 0 <br /> 1 0 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> c,�j� OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 0 ev /99J """"" �/""".r Correct CONDITION(S)? Logged in LAND USE BOOK? <br />