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NOTE: PULL ALL PE A\'S (SEPTIC WELL, ETC...) N. E COPIES FOR FILE <br /> LAND USE REPORT APP# /04-0 71 -�S 61F_ <br /> EHD RECEIVED APP.REFERRAL: J ' —0-d. COMPLETE & SUBMIT BY—j t11 V g a <br /> DATE DAtE <br /> ATTN: <br /> SITE ADDRESS: Srl <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 /> v ` <br /> I recommend: Approval Denial Continuance Inspector's Signat <br /> �c�etk9c3c*9r�k�oEvEkaE�3cdc*hdckdciraFicaF-1r�lrick�r�'raF9c�c�cick3c�r�cx�cicir�ciricx*:Eicic�cx9cirxxxdciex�ckdr�e*ic�c �r�r�c9r� c�ciricxisir9c9civk�c�c <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA IT CHECK OFF LIST X" .ProofreSad repotr� Correct LAND USE#?a <br /> ri CorrTION ect CONDI � ed rrr LAND USE B <br /> EH 06 06 Rev 1199 <br /> { Lo gg <br />