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NOTE: PULL ALL PERIL S (SEPTIC, WELL, ETC...) KE COPIES FOR FILE <br /> LAND USE REPORT APP# P�-- r�• - ?S [_� ,�_ <br /> EHD RECEIVED APP_REFERRAL. �J 2 COMPLETE & SUBMIT BY_ <br /> DATE �} DATE <br /> ATTN: rr <br /> SITE ADDRESS: O S <br /> 01 <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 /> Jv- <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> 9c*�c$cic*k�'cds:E aF kik�k�E�kxit it it�c 9e�r�e xde de kie 3c�c�F*�c:Eic*�F do do 9c�9r 9c�'c$t9:��c 4t��:*�e9:�F�e�c aF�e ae ie ie is it 9c is is�c kik�c do aF�c��r�'t 9t�e�e 4e ie�exxdr�c is�r <br /> Supervisor/Lead Senior Comments: <br /> � y <br /> P <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OAYI CHEek OFFLIST� ����P +`Proofread report? Correct LAND USE#9 <br /> EH 06 06 Rev 1199 q ' � � .Correet CONDITION{S) Logged in`LAND USE BOOM <br /> " <br />