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TT <br /> .,NOTE: PULL ALL PEk_,�ITS (SEPTIC, WELL, ETC...h� AKE COPIES FOR FILE <br /> LAND USE REPORT APP# -Oa - lea 0 C4A) <br /> EHD RECEIVED APP.REFERRAL: a S� COMPLETE & SUBMIT BY kqAPAY' 'V <br /> DA `DATE' ■ , <br /> ATTN: CL. G C) " <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: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> I <br /> I <br /> I, <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �e�E�Fic9r�rica"rdekx$e*9ck3c�c*�fcnkk$e�'cx�ea'r�t9e9c�E�cdcdc:E-lczYic�rdeirx�fr�'c��ek$t�t�Edr��k9ric��kdex9c�'s�cdc*ac do do aciciria�cirdr �e1roF�t�t�Fdc 3r ic�coF*ic <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> . V <br /> SOA II CHECK OpF'LIST';�:�`� �` Proofread report? ' '- ""Correct LfIND USE#9�� <br /> EH 06 06 Rev 1199 <br />