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�� E: PULL ALL PERl1 S (SEPTIC, WELL, ETC-) P E COPIES FOR FILE <br /> CG &J <z (0 <br /> LAND USE REPORT APP# FA- - Oa- 371 4 61'--0a -3:;Q <br /> EHD RECEIVED APP.REFERRAL: -GV -A-. COMPLETE & SUBMIT BY C7 <br /> DAT 1 / ATE <br /> ATTN: <br /> SITE ADDRESS: �. <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 /> J J9 <br /> v d <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �kle�e�'e-Je$r�e�x9r�k9e�E�e�F$*3e�4dr�F�r�rdeirhde�'edeeF�e�rKirx9t9r�kxxxie�ex9c�kdc$r�Firic�ciedexieiexx�r�ic$e�'c�c�F�kicdc9ede:E�FkvF�ca�c�kaF�FivdedeoF�c�cvEk�vE:E <br /> Supervisor/Lead Senior Comments: <br /> r L/44A <br /> I, <br /> V IV <br /> Pf <br /> A <br /> At <br /> 1 ' , <br /> � 1 <br /> IV <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 11 CHECK OFF LIST` ,k ..:Proofread report?, v Correct <br /> ` "C;ire't CONDI7TON(S) <br /> In LAND IISE BOalf <br /> EH 06 06 Rev 1199 wY r, 9 s <br />