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� '� M�E COPIES FOR FILE <br /> PERMI SEPTIC, WELL, ETC...) <br /> NO'T'E: PULL ALL { <br /> LAND USE REPORT APP# -� <br /> x <br /> COMPLETE & SUBMIT BY <br /> k EHD RECEIVED APP.REFERRAL:DATE DATE <br /> ATTN: <br /> ala k <br /> SITE ADDRESS: - <br /> In completing the Land Use investigation, draw all Public Health-Jctors 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: /1?0 Public sewage: X70 <br /> SUMMARY OR COMMENTS: <br /> oP <br /> tea, o <br /> I recommend: Approval Denial Continuance Inspector's at r <br /> Supervisor/Lead Senior Comments: <br /> -7, ' 01 <br /> 8 : Cj?, <br /> z d <br /> a : � y <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> SOA°IIGHECK4FF�ST' Proofrend7eporl� . CrirrectL:�IND�,USE#? <br /> ,: � `.` Corrt�GONDTI T(��CS) gg Ia,rlNb IIS�E'B�b07C?' <br /> E <br /> EH 06 06 Rev 1199 ? �� <br />