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_ lei <br /> NOTE: PULL ALL PE 1 fS (SEPTIC, WELL, ETC...) 1V'llE COPIES VOR FILE <br /> LAND USE REPORT APP#_jPi;- -03 61-tq) _ <br /> EHD RECEIVED APP.REFERRAL: q/03 COMPLETE & SUBMIT BY �/ l!0 <br /> DAT11 I DATE <br /> ATTN: KT <br /> O <br /> SITE ADDRESS: d Com.- ..rA� U I <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 /> I recommend: Approval v"" Denial Continuance Inspector's Signature` <br /> *****dr**3e*$t�r�e*e�eeka�c****�e�e�eJcie****4t�'ele*Fic9c*it*�eYde�k******�t�r�e�ek�rxir*****>t**icir***9exx*k9c*�e$c9rxdeixic*dex* <br /> Supervisor/Lead Senior Comments: <br /> a a 3 01.. <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA'`1I CHECK OFF LIST ' Proofread report ' Correct LAND"USE#9 <br /> Ello6 ob ae� v99 �Y Cotrect CONDI <br /> TIONS}� Lagged fn LAND USE BdOK� <br /> ° >, �.� <br />