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(NOTE: PULL ALL PE1RP_,TS (SEPTIC, WELL, ETC...) ,FAKE COPIES FOR FILE <br /> LAND USE REPORT <br /> EHD RECEIVED.APP.REFERRAL: L_DATE <br /> �—a, COMPLETE & SUBMIT BY <br /> DATE <br /> ATTN: <br /> SITE ADDRESS: 2 ()t,/ C/ <br /> 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 /> recommend: Approval Denial Continuance Inspector's Signat=T —-- <br /> Supervisor/Lead Senior Comments: <br /> 644,=1" <br /> au = % ,,; <br /> � .U1 -� <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST., _Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 _Correct CONDITION(S)? Logged is LAND USE BOOK? <br />