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" ; t <br /> NOTE: PULL ALL PERi.�ATS (SEPTIC, WELL, ETC...)-,aAKE COPIES FOR FILE <br /> LAND USE REPORT APP-4 -(,D <br />' EHD RECEIVED APP.REFERRAL: "1 a 9 COMPLETE Bit SUBMIT By' 22-. <br /> 22-. _ <br /> DATE DATE <br /> A�T7,TN: -1- <br /> C � �J <br /> SITE ADDRESS: `7 c _ Uc 12,5 A,6 __ " _ �r•�„_.,_,_,__ _.._..__ <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 ofplain paper, draw completed map of area <br /> showing population density, location of house, wind direction, etc.... <br /> Public water: &A-- Public sewage: <br /> SUMMARY OR COMMENTS: <br /> /d rA "7 /'ZP)C)9 L 0 TTS , A,5_CV_4AC, VP-9g _ 1"7 <br /> I recommend: Approval a Denial Continuance Inspector's Signatur <br /> Supervisor/Lead Senior Comments: <br /> Com-. <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA'II CHECK.OFF LIST.. Proofread report?- " Correct LAND USE#fie <br /> EH 06 06 Rev 1/99 .- �orrect CONDITION(S)sLogged in LAND USE.BOOK? <br />