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r � <br /> f NOTE: PULL ALL PERM1'I S (SEPTIC, WELL, ETC...) ?VrAKE COPIES FOR FILE <br /> LAND USE REPORT APP" P GI 8— x <br /> EHD RECEIVED APP.REFERRAL: I l �O COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: Q(- <br /> In <br /> 1 •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: �r Public sewage: <br /> SUMMARY OR COMMENTS: <br /> r <br /> L dr- <br /> 01 <br /> or <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �c de aF�e 9e�c 9c 9c�e 9c 4r>ie�e eF�e k�e'c�e�e�r�e*k$e�c e F FkkeF k ie 'ex�e 9c 9e it�c c 4e�e F k$cF�c iv c at$c 9e�e ie�e 4r 9c sir�e ie vY e$ekx'e Je�e�e F a'c iee x6r rie'e�� cx <br /> Supervisor/Lead Senior Comments: <br /> VV <br /> e <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CIIEGl�OFFLIST ` lFroofread report9 Garrect LAND YFSE"#v <br /> 3 €` ' correct CONDITION(S)? Logged in"LAND USEBOOK7 <br /> EH 66 06 Rev 1199 t <br /> a5..a <br />