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P.OT,iV- PULL ALL PER.. TS (SEPTIC, WELL, ETC...) ,AKE COPIES FOR FILE 7T <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY ' <br /> DA E <br /> DATE <br /> ATTN: <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: vy ,� Public sewage: <br /> SUMMARY OR COMMENTS: <br /> 5 Ac `1a ♦`I lc�1 r1 1�tSS 1 2\7 -0 <br /> p <br /> Qv.vs�cro <. AA"Ci w0.STc Wc� =�CWn /a dSN tioJ_ -Y <br /> �G�vy /yM�I�7 "tom <br /> 1 recommend: Approval ✓ Denial Continuance Inspector's Signatur <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> O.t II CHECK OFF LIST: _Proofread report? Correct LAND USE#? <br /> EH ov oG Res P99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />