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PULL ALL PE �S SEPTIC, WELL, ETC...) M'B'E COPIES,FOR FILE / I <br /> LAND USE REPORT APP# ' — "-� 7 m-) <br /> • L "17-o COMPLETE & SUBMIT BY `" -02 <br /> EHD RECEIVED APP.REFERRAL. <br /> DATE DATE <br /> ATTN: 0-ort-r J <br /> SITE ADDRESS: 0 -� <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 trap of area <br /> showing population density, location of house,wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> *****9e*$e**�czF****9e9:****-!c**Eie�4k�e'ezc�ck**�rx**�kic*E*4t�eieie*�cxicicic***9cit>c�rx*�c**9t�e�e'e3c***dc$t�rJcdcdc***dcidx*xir <br /> Supervisor/Lead Senior Comments: <br /> 6 ; ay <br /> o : d <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA Ij CHECK OFF LIST: Proofread report. Correct LrIIY,P[ISE#9 <br /> EH 06 06 Rev v9q � �, �� Correct CONDI7701V{S)� ` Lagged rn LAND t1SE B40S? 3 <br /> a <br />