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NOTE: PULL ALL PERJ,,.S (SEPTIC, WELL, ETC...) A XE COPIES FOR FILE <br /> LAND USE REPORT APP# (j -aa <br /> EHD RECEIVED APP.REFERRAL:a:±7 '� COMPLETE Bt SUBMIT BY rj a <br /> DATE ll � ll n n ' DATE <br /> ATTN: �N�t r�Cl 'L{ 1 V UtZh'yA <br /> SITE ADDRESS: a <br /> In completing the Land Use investigation, draw all Public Health factors on the exhi it(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: OTy 6:E Public sewage: rjE�- /7;e-- <br /> SUMMARY <br /> }ySUIS RY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> D , <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> V Ll <br /> OA I/CHF.CK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />