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4 � <br /> NOTE: PULL ALL PE%,,, AS (SEPTIC, WELL, ETC...)3AKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br />! Mcg t — � <br /> EHD RECEIVED APP.REFERRAL: V� COMPLETE & SUBMIT BY S �� f C} <br /> i <br /> 5ATE ++ DATE <br /> ATTN: I <br /> SITE ADDRESS: _I d q IA Aj r earIn 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 /> 1 <br /> i <br /> 1 <br /> r <br /> k <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> dt�eJe9e*eFx�k�e9rae9r3e�ric�'c9riede�c�roF�ck�r�cKF$c��cE�x!rEkxxxxirxxx�r9ex�c�r9cx9e$c9c�F�e9e9cxeFx�r9cx�r�F�c$co'e$e�te�ex�e�eirY�c1e $eJr�ak�ek�F�k <br /> Supervisor/Lead Senior Comment <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST f Proofread iepart� Correct LAND USE#?< ; <br /> EH o6 06 Rei 1�g9 __Correct CONDLTION(S)h � Logged in LAND S.. WOK? <br />