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NO'T'E: PULL ALL PERI I S (SEPTIC, WELL, ETC—) V'—VE COPIES FOR FILE <br /> LAND USE REPORT APP#� Oa <br /> i <br />!' -va COMPLETE / (� o� -10 d1. <br /> EHD RECEIVED APP.REFERRAL: & SUBMIT BY — <br /> DATEDATE <br /> DATE <br /> OSS � <br /> ATTN: {6 EGi el e r <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: C5 Public sewage: �p <br /> SUMMARY OR COMMENTS: <br /> td Ae cwt ��re t, a e LP _ e- 02 <br /> 5 ti V 11 <br /> 1,0- VTS L+ a r, ]a - 0,7- no s Sce 1,dd Se-4410 r ce Lj21rrc,7& 43 �u <br /> — <br /> 1 e S <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> ode�r at*x�e�e keF Jr�c�r arc�r it k�c�e a�c��r�49e�'e le sir de�r,c�r*dc Jr 9r hex de�e�r�c*dc 9e 9c qtr�c k�r�rx�ex�e ie is it 4c�c�k�r$e�F de tk�xic a�ie 9c-h3c*aE�k�cx�r$c>c�F�e dr�c 9c�'r is of�c <br /> Supervisor/Lead Senior Comments: <br /> p <br /> y y :o <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> 4A II CHECK QFF.LIST Proofread report?." �,° Correct L&D USE#9 <br /> LAND USE <br /> EH 06 06 Rev 1199 sc � { "Cnrtect © D1'TTON(S) Fogged'm BOQK� <br /> a <br />