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NOTE:,tPULL ALL PER S (SEPTIC, WELL, ETC...) NiLAKF COPIES FOR FILE <br /> Irf <br /> LAND USE REPORT APP# —00 -El <br /> r-oa <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BDATE <br /> Y <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: Public sewage: <br /> f <br /> SUMMARY OR COMMENTS: <br /> ev <br /> I recommend: Approval Denial Continuance Inspector's Signature's <br /> Supervisor/Lead Senior Comments: <br /> 0 <br /> ' r <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> `4A II CHECI�C©1°F�LIST ,� �a` `Proofread xeporf� 9 "�Correct 1�:.9ND rISE#9 ` ` <br /> EH 06 06 Rev 1199 <br /> :;+�•_..-.�$�,.ri^.-?..rs..ser, E.. ��PC.,..&3.n k. ..0;i? -)eG-...xrt <br />