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NOTE: PULL ALL PERI��� (SEPTIC, WELL, ETC...) fvt E COPIES FOR FILE <br /> LAND USE REPORT APP# Pa-D -3 1v �L4 <br /> EHD RECEIVED APP.REFERRAL: 1-3 -0),- COMPLETE & SUBMIT BY_ 3 1 �' �'9 —U <br /> DAT DATE <br /> ATTN: 1i�1r � <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 reap of area <br /> showing population density, location of house, wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> L <br /> I recommend: Approval Denial Continuance Inspector's Signat e <br /> �cir�rie4cdexaFde�eJe�eir�9e9r9c�dc:EvEkic�F�2$c-Jc�r�c9c9cxxx�cvk3e�k�'F�kdr�'c�ea'edea'edr>c$r$ttk$r�tdc3cicicivic�iirxxxxicfc3:Jr�F�k x�exlcx3cxxx9exx -�e�ve�lr <br /> Supervisor/Lead Senior Comments: <br /> :0 <br /> I <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> �A II CHECK[?FF LIST Proofread report. Correct LAND SSE#? <br /> EH 06 06 Rev 1149 �' Correct 'Logged in LAND USE BOOK? <br /> CONDI x <br /> n 0 <br />