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�' : PULL ALL PESEPTIC WELL, ETC...} �'��,KE COPIES FOR FILE <br /> E RM„ ( VIM# <br /> LAND USE REPORT APP# 9.3 <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY <br /> DATE n DATE <br /> ATTN: <br /> SITE ADDRESS: .� J .✓� -� �C� . ?`rr� - <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 /> - <br /> ✓-o� <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> ji��--� <br /> Supervisor/Lead Senior Comments: <br /> 6q <br /> w <br /> :o <br /> :o <br /> S":o <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA'11C, HECK OFF LISTS Proofread report? &. Correct LAND,USE#' m <br /> rCorrect CONDITI011t(SJ Logged in LAND USE BO0K-' , <br /> EH 06 06 Rev 1199 <br />