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'�E COPIES FOR FILE <br /> NOME: PULL ALL PE�� �i (SEPTIC, WELL, ETC- , <br /> � <br /> LAND USE REPORT APP <br /> EHD RECEIVED APP.REFERRAL: 11—L —01 COMPLETE & SUBMIT BY A 9 AP%RV- <br /> DATE 8 1%0 bA <br /> V-DATEA It <br /> ATTN: ' 1 tl,-.� L a <br /> SITE ADDRESS: I CC" <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 /> Al 6 <br />} <br /> I <br /> k <br /> R f� <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> Clr1'II CHG1�dF,LISA" Proofread report? fi Correct LAdVD USE'#9 g <br /> � orr'ect CONDITIONS) Logged in LAND USE BOOKS ` <br /> EH 06 06 Rev 1/99 '� � �., � .; �_, . <br />