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';JNOTE: PULL ALL PERIS (SEPTIC, WELL, ETC...) OKE /y <br /> COPIES FOR FILE <br /> LAND USE REPORT APP# -50 L,q <br /> EHD RECEIVED APP.REFERRAL: ( 4 6--021— COMPLETE & SUBMIT BY � <br /> /� <br /> DATE / — `7 � —� <br /> ATTN: y .� / DATE <br /> SITE ADDRESS: Ce, <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 /> �A <br /> i <br /> i <br /> I recommend: Approval Denial Continuancec <br /> eE�c�r�r*tEdc$exx�ic*x�cdcTcxxEFic$eJr�1r*$9e��tF�c9ex�t�E�c9r�rx�F�k-frekk$c:E$ckx�'sdco4dexvF*Sxl)ec#OXx�*ig�Iiature �c9c*�kie$x�c �tk�c�c <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> 4A II CHECK QFF LIST ��� Proofread report� i' ° � Correct.LAND USE#? <br /> EH 06 06 Rev 1199 <br /> ;�� � �������'��Carecl CONDITION(S)? - � Loggeif fri LAND USEBDOK?. ,„ <br /> i <br /> l ( ; <br />