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i 7—W <br /> NOTE: DULL ALL PERM-t-YS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP#� ,S r94 - 9 9 - !2 <br /> EHD RECEIVED APP/REFERRAL:,. -qq COMPLETE & SUBMIT BY g" 00 <br /> DATE DATE <br /> ATTN: 1 l-. <br /> SITE ADDRESS: n <br /> 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 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 /> oe <br /> I recommend: Approval Denial Continuance Inspector's Signatu5o" <br /> Supervisor/Lead Senior Comments: <br /> 0 <br /> J <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK Q F LIST `Proofread repo ? Cr�rreet LAND 11SE#r <br /> r ` ' Correct CQNDITIDN(S)9 , m�"Logged rn LAND USE SQQff? <br /> EH 06 06 Rev 1199 <br /> 3 <br /> , .... 3"��. t;. .... rsdxStk=. <br />