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,NOTE: PULL ALL PEW"-7S (SEPTIC, WELL, ETC...) M {E COPIES FOR FILE f <br /> LAND USE REPORT APP# -0 —S V 0 62-ova � <br /> EHD RECEIVED APP.REFERRAL: lv I-I UZ- COMPLETE & SUBMIT BY .• �tl�sZ <br /> DATE DAT ` <br /> ATTN: kj` viovdAne <br /> SITE ADDRESS: <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: -,i) Public sewage: <br /> SUMMARY OR COMMENTS: <br /> 1,.4 <br /> M � o rJ�ter�, ae e e <br /> I recommend: Approval ,l Denial Continuance Inspector's Signatur <br /> de$r�t�F�Fir�r�4ek�e$c9r�Eic�r9c�'eaY�F�c9s�Fic9c�ex�e��<�e9r�cicicicir�Fie�r�e$t9t�E�F�ricie�e��Ir�EvF:E�rhxx9t�cdrjc*�Irx$ek�e�$t9c�E�Fic�ci� n ok�t�'s�k�c�rickieieieie <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> f/ <br /> OA II CHECK p,F F LIST�� R Proofread report�� . Correct LAND USE#9 <br /> EH 06 06 Rev 1/99 �a� � C0rre'c1 CONDITIUN(S) �' Lpgged in LAND USE BOOK? <br />