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!. Y `00 <br /> NOTE: PULL ALL PEhITS (SEPTIC, WELL, ETC...} AKE COPIES FOR FILE <br /> LAND USE REPORT APP# - (� <br /> EHD RECEIVED APP.REFERRAL: I - I� _ COMPLETE & SUBMIT BY 03 <br /> DATE — <br /> DATE <br /> ATTN: <br /> SITE ADDRESS: v <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 /> ` „�✓t/ � i�L t �' ""' y �� !� -� �./� lac=��1� <br /> I recommend: Approval Denial Continuance Inspector's Signatur 1-17 <br /> �c is�k dr nF��F aF is 9e�F k 9c�e�c:r*ir$e�e�t c*a�r$Xic e>tac*dc�c•IrXie%�F Xic i�e*k�rFX3c dr F:k sir ac dr is 9r*�ex9r do:F i��F k3e F k plc k3ck�c ie is de �c E is it�c icxirx�'9ck <br /> Supervisor/Lead Senior Comments: <br /> 5W6 A6n �s <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> 0. II CHECK OFF LIST k€E Proofreai report?i ' Correct,LAND USE#9 1. <br /> EH 06 06 Rev 1199 <br /> ` `Correct CONDI?IOIV S ? .sv. z <br /> (} Logger!rn LAND USE BDOK <br />