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28 <br /> NOTE: PULL ALL PERK rFS (SEPTIC, WELL, ETC...) ,,tKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: / V D.3 COMPLETE & SUBMIT BY / - a. - U <br /> DAT <br /> DATE <br /> ATTN: {„ CL_ r1 ✓1 e- till e (/(-j r <br /> SITE ADDRESS: <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 /> f W6 <br /> .2 Ott <br /> 6 - J :o/ <br /> , <br /> ILA DS r ii1,4.bi <br /> I recommend: Approval Denial Continuance Inspector's Signature a <br /> xxKx*x**Kxxx*xxx***x�xxx***�xxxx*+xxxxnxx*�*:��Fx**�x**x�tx;�xxxxxxxxxxzxxxxxxxax*t*xx•�x�a:t,v <br /> Supervisor/Lead Senior Comments: <br /> /.o u. <br /> fo <br /> r <br /> SUPERVfSO&LEAD SENIOR APPROVAL: <br /> r <br /> OA II CHECK OFF LIST., _Proofread report? Correct LAND USE#? <br /> Eli 06 06 Rev 1199 Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />