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NOTE: PULL ALL PERI%-.,c 6 (SEPTIC, WELL, ETC...) i;E COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL- ' ���p 1 COMPLETE & SUBMIT <br /> DATE <br /> / ATE pl f <br /> ATTN• <br /> SITE ADDRESS: a 5 4 <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 /> E <br /> w <br /> I recommend: Approval Denial Continuance Inspector's Sign <br /> Supervisor/Lead Senior Comments: <br /> i <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OX H CHECk OFF LIST x * 'Proofread report?�� Correet LAND USE#g <br /> Eli 06 06 Rev 1199 i -Correct CONDITIONS}? "Logged to L VD USE BDOK7 <br /> e <br />