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J Y <br /> /i NOTE: PULL ALL PERMI1S (SEPTIC, WELL, ETC...) Nlbl" COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: _ COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: J <br /> SITE ADDRESS: g �w <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 /> o <br /> b:oq <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> k � r <br /> JV f <br /> dot <br /> V 61 <br /> OS: x <br /> d , <br /> S n <br /> SUPERV SORIL�EAD SENIOR APPROVAL: <br /> QA II CHECK dFF LIST s �raofread teport?� °_.Correct LAND USE <br /> #9 <br /> a " _ Correct CONDITIQN(S) kLogged eri USE BQOIC? <br /> EH 06 06 v 1199 <br />