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1 <br /> NOTE:_-,PULL ALL PE �S (SEPTIC, WELL, ETC...} �> E COPYES FOR FI <br /> PERI <br /> LE <br /> LAND USE REPORTAPP# O a <br /> .I <br /> ��}' o7- � <br /> EIID RECEIVED APP.REFERRAL: '! ~ 7C)Q_ COMPLETE & SUBMIT BY - / - 0 a <br /> DATE <br /> DATE <br /> ATTN: [ <br /> SITE ADDRESS: So o0 <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 dens'ty, to tion of house, wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> --- � . <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �Edr9cx�r*��c�E-Jc�r�kdc$eK9ck**�k�k�e$t�cir�rkiciek�Y9e�t9cvEnFak�c9c$eJc$r9cdc$r9c�r:F$e9cx�F�Fdr�ek�FxxKdcxx�cft�r�k�kx$4rvE�FdciaFc $e 9t 9rvcdc�cac*9e dr re <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: - <br /> OA lI CHECK OFFLIST Proofredaf reports Correct LAND'USE ._ <br /> EH 06 06 Rev vg Correct CONDITIONS)? Lagged in LAND USE:BQOX? . `' <br /> Z 3 <br /> i <br />