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NOTE: PULL ALL PERI S (SEPTIC, WELL, ETC...)`ir KE COPIES FOR FILE <br /> s <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: 3COMPLETE & SUBMIT BY �� f <br /> DAT &-b 3 <br /> bATE <br /> ATTN: �_�Q`�� eo ec _ <br /> SITE ADDRESS: qM� <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 /> ZPZ�: 0,5- (J4 <br /> I recommend: Approval ✓ Denial Continuance Inspector's Signatur <br /> is is ie ie air*k�'t�t�c�t it 9t 9c$c kvF kF�c k9c 9c�c 9r it�k do de ak is ie ie'e�e�rxic$r�'c�'s 9t��t�c do ick*ic�k�c k�iex�r$t�t ie!c E do icx�c do it is it ie�F is icxxde kdr�exxie�c ie de-lr de keF <br /> Supervisor/Lead Senior Comments: <br /> .o <br /> i <br /> i <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA TI C i�ECK OFF L�S7 P ` Praafread report correet L9ND USE ' <br /> EH 06 06 Rev 1/99 ��M�n� Correct CONDITION(S)7 �k� `Logged m LAND USE BOOKS <br />