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NOTE: PULL ALL PERIVIS (SEPTIC, WELL, ETC...) 1Vz-,,KE COPIES FOR FILE <br /> LAND USE REPORT APP# _P,4_-Z) <br /> EHD RECEIVED APP.REFERRAL: Q- "[ () COMPLETE & SUBMIT BY ASARAY, <br /> � j <br /> D F 11 DATE ` <br /> ATTN: �1j tv� -- ,M (J ren <br /> SITE ADDRESS: b <br /> In completing the Land Use investigation, draw all Pub is 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 wate Vj _ Public sewage: _h)jA,, SQ rO�`fit <br /> MARY OR COMMENTS: <br /> i —vitz� <br /> I recommend: ApprovDenial Continuance Inspector's Sign atur �. <br /> �ric9cx�rfe*$*Fcie�a'edriekaF'tde$ex >'e �clt�r�txxx9e9r4r9r�cx�t�rt'c4cAcx�ex7trk��ckFicir�k3c�Yiric$iedriexF'ce$e'cie'c1cFir xx�c�c$cxx3cx$ekx�c-lrxx <br /> Supervisor/Lead Senior Comments: <br /> u <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> �,QA 11 CHECK OFF LIST Proofread report?x.3 Correct LAND USE#5 , � <br /> EH 06 06 Rev 1/99 ` " �'� � Correct G©�VDITION(S)? Lagged En LAND tISE BOOK? <br />