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F � �� � R FILE <br /> :-VOTE: FULL ALL PL+frctVl_..& (SEPTIC, WELL, ETC-("N COPIES FOR <br /> LAND USE REPORT APP# X04 --v —33 <br /> � <br /> /!?,oP <br /> EHD RECEIVED APP.REFERRAL: S 25—01 COMPLETE & SUBMIT BY `v <br /> DATE DATE <br /> ATTN: t �- n1 (/ e t l aC ' <br /> SITE ADDRESS: & 8r20 fes- llev S � <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 />�j <br /> i <br /> d <br /> I recommend: Approval Denial Continuance Inspector's Signa re ' <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA I�CHLCIC OFF:LIST Praofreatd report?r 'Correct LAND USE#P <br /> � a���� �r ���"Gorrect CONDITION{S)7-�� �`y °Lagged rn LAND USE BOOH7 �.�' <br /> EH 06 06 Rev 1199 <br />