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,PE <br /> NOTE: PULL ALL PERNtrfS (SEPTIC,WELL, ETC...) NrAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: 4'60 COMPLETE & SUBMIT BY .5 -/6 —() o <br /> DATE DATE <br /> ATTN• n ; unmj <br /> SITE ADDRESS: 7 Co c) . !5 L 54y,-e e- <br /> In completing the Land Use investigation, draw all Pu lic 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 recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> © y <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />