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_ l T <br /> NOTE: PULL ALL PER ?TS (SEPTIC, WELL, ETC...) AKE COPIES FOR FILE <br /> LAND USE REPORT APP# am <br /> EHD RECEIVED APP.REFERRAL: U p2 COMPLETE & SUBMIT BYAR A <br /> DA <br /> ATE' <br /> ATTN: f <br /> SITE ADDRESS: �" f <br /> In completing the Land Use investigation,draw all Publicealth 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: A 6Public sewage: <br /> SUMMARY OR COMMENTS: <br /> I Aid * A — Q So3 /5A) els AA i (S <br /> i <br /> I, <br /> li <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �tirdc$rX4cdc-Jririe�r9r9cdciciekx�ck9cic�kxxit�cdckic�c�kxx�'t�kdcici��r�kk*�c9c:E�c�e�e�:$t:E�E9r*k>c�c-Jc�e�'rxxeF;kaEdc$9ede�e�F9cdck$c�r�k�c�e4s�FicaFisxxx�:�F <br /> i <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> _OA If CHECK OE]�DIST, � Proofread repast� Cua�rect L 911'D TISE#9 <br /> EH 66 06 Rev 1149 <br /> ��� Correct CONDI TIDN{S)?� _-: Logged rn SAND SSB BOOK? . <br />