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s NC;TE: PULL ALL PERT TS (SEPTIC, WELL, ETC...) P3KE COPIES FOR FILE <br /> LAND USE REPORT APP# M S—C2/-- <br /> EHD RECEIVED APP.REFERRAL: D ,�O02- COMPLETE & SUBMIT BY --QZ- - <br /> DATE <br /> ` _ DATE <br /> ATTN: ^,_J��� 46 � <br /> - <br /> SITE ADDRESS: L , c� <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 I l <br /> J <br /> AIL L t b4 z 460.rl�� <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Fkirirocicic4�cir�ek�ex�r>eeF9cFcdcicYic'czcicielcx�kJc3r�e*e�r�eieicF�edc�r4x�t4cdcicicir�ciciexx*de�ekxk9t4t>'c9e�'e9c9rdckF!rtE:FE'cEdcdcaFk9c$sc:EEkE <br /> Supervisor/Lead Senior Comments: <br /> w <br /> � . :.Q <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF., `Proofread report? Correct WAND USE <br /> EH 06 06 Rev 1/99 Correct CONDITIONS} Lagged in LANA USE ROOK?, <br />