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h NOTE: PULL ALL PERI 'L'S (SEPTIC, WELL, ETC...) TKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: !�/ �_D� COMPLETE & SUBMIT BY <br /> DATE HATE <br /> ATTN• <br /> ji 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: <br /> SUMMARY OR COMMENTS: <br /> L�LI C .�4?1l7Gfx� 47 f. � <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �c�rde�k�kaY�;�'�9eJr�EvE�'r�cic�F�rieJe�eJr�'ele�e�e�r9eds�c:E$s-Jr3c�r�'eae�F�edeie�cnkelra��eJe�r�'e9c�c�ck�cok�rdeekx�r9r�F�eisdc�cicx�e�'c�'r�tr9c�r9eeF�e�e�EFieaFie�Fo49r$cFede* <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> SOA <br /> EH 06 06 Rev 1199 ; � �g Correct C01DiTI01V S � Ln eft ne <br /> f) gg �4ND USEBQ01� � , <br />