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6/TT <br /> NOTE: PULL ALL PERTWri'S (SEPTIC, WELL, ETC...) N---rtKE COPIES FOR FILE <br /> i <br /> LAND USE REPORT APP# D %l � <br /> �-" <br /> EHD RECEIVED APP.REFERRAL. 4/yL1�' COMPLETE & SUBMIT BY c(S J 6 <br /> DW DATE <br /> ATTN: <br /> SITE ADDRESS: a 0-7 kzi <br /> In completing the Land Use investigation,draw all Public 147ealth 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 /> 7/3d dZ r_ a .� •b� p� of 7 S v o rr"1 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> :o ✓ ✓ i <br /> C_ // - a3y <br /> D 2 a ' O / <br /> J <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> ECK OFF LLST: Proofread report? _Correct LAND USE#? <br /> OA/I CH <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />