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fJyl ti tr <br /> lYU'TE. 1�ULL ALL PER 11 jS (SEPTIC, WELL, ETC...) KE COPIES FOR FILE <br /> LAND USE REPORT APP# /q ~S If <br /> A Q P-B)�, <br /> EHD RECEIVED APP.REFERRAL: a �� COMPLETE & SUBMIT 6 O lfti <br /> DATE <br /> DATE <br /> ATTN: An-c,-�- J?Aa n e S <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: It <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature r <br /> Supervisor/Lead Senior Comments: <br />,i <br /> i� <br /> s <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA7I CHECK OFF..LIST Proofread report? Carrera LAND USE#' <br /> EH 06 06 Rev 1199 <br /> , � Cgrrect <br /> CONDITION(S) <br /> ` Logged in LAND USE BODI[? y. <br />