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NOTE: PULL ALL PERK TS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FELE <br /> LAND USE REPORT APP#r, P—OI -(9VZ7, <br /> EHD RECEIVED APP.REFERRAL: - P —dl COMPLETE & SUBMIT BY 3 — Q 8 - O/ <br /> DATE DATE <br /> ATTN: a <br /> SITE ADDRESS: 3 <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...,. r <br /> Public water: N Public sewage: N (� <br /> SUMMARY OR COMMENTS: <br /> lr l�• �h.o Q h�� a•••—, <br /> I recommend: Approval /Denial Continuance Inspector's Signatur <br /> Supervisor/Lea;Zi r Comments: <br /> to V <br /> `e raw <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA/1 CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> \ EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged In LAND USE BOOK? <br />