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NOTE: PULL ALL PE QTS (SEPTIC, WELL, ETC...} JkKE COPIES FOR FILE <br /> LAND USE REPORT App# <br /> EHD RECEIVED APP.REFERRAL: 1 /7 D3 COMPLETE & SUBMIT BY AR, -Ry: v <br /> D&E - DATE <br /> ATTN: <br /> SITE ADDRESS:: <br /> In completing the]Land Use investigation, draw all Public Health factors on the exhibit (Le..- 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 /> -- Gov-�rlc.���•�i1� <br /> I recommend: Approval Denial Continuance Inspector's Signa <br /> cA;��v <br /> $r�c�r�frkx�'rds3r*��e9cFarhx'r�e�cicir�k�r9t4c�EnEkir�k9c�rtFicicisec�e*�eJr��49caF�e�c�c*�rdex�r$cic�FkF>coF*icle3eJe�e�'e�nEirirxk�$c�icdc�cdcxFKkFcicdc <br /> Supervisor/Lead Senior Comments: <br /> 4 AAP <br /> SUPERVISOR/LE.AD SENIOR APPROVAL: <br /> DA II CHECK OFF LIST � Proofread reporl?� Correct LAND'USE#? <br /> EH od 06 Rev v99 r O'orsect CONDtTION(S) 3 fagged in LAND USE.BOOK�?'_ <br /> {p <br />