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NOTE: PULL ALL PERIA. -S (SEPTIC, WELL, ETC...) -.,,1KE COPIES FOR FILE <br /> LAND USE REPORT O� APP# <br /> EHD RECEIVED APP.REFERRAL: <br /> DATE COMPLETE & SUBMIT BY <br /> / <br /> E. <br /> ATTN: k ,n(�r�� <br /> SITE ADDRESS: � J� (� ! S ) rn Zt- g- t <br /> In completing the Land Use investigation, draw all Public Health factors the he 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: /Xj Public sewage: <br /> SUMMARY OR COMMENTS: <br /> /1 <br /> //Y�IY nFr�/i.Cf Q/� r'k-"1f�,��y- •� s�i- � -ren � � <br /> //'OIC .Of ,�.rSfP Yr- <br /> -sem-nC <br /> I recommend: Approva Denial Continuance Inspector's Sig re <br /> Supervisor/Lead Senior Comments: <br /> VU <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> [O�A �OFF LIST.* Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />