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NOTE: PULL ALL PERI Wrs (SEPTIC, WELL, ETC...) *AKE COPIES FOR FILE <br /> LAND USE REPORT APP# " e v ae / <br /> EHD RECEIVED APP.REFERRAL: . COMPLETE & SUBMIT BY -- I -d <br /> DATE DATE <br /> ATTN: <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 /> oi✓ <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> omments: <br /> i/ (��LLL_ Vv <br /> ' o tiw�fi tP� i 7O / 7N� <br /> tl <br /> r <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: _Proofread report? _Correct LAND USE#? <br /> EH 06 06 acv 1/99Correct CONDITION(S)? Logged in LAND USE BOOK? <br />