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J Y <br /> NOTE: PULL ALL PERI.ATS (SEPTIC, WELL, ETC...)_4AKE COPIES FOR FILE <br /> LAND USE REPORT APP# -01 - . I <br /> EHD RECEIVED APP.REFERRAL: [ ' S '.0 I COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN• Le- -one ye-d e c <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 /> SUMMARY OR COMMENTS: <br /> D Il/�4Jdo&Dt ?Trary e}� T�� 7'i <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> a'e*kxeFr$c�r kik�'e xde k�cx�e��F:E�e�r�fr it�e 4c 9r�ex�F:F�k 3e�r 9e 9e�e�e k 9e rr$e�'e�e$e�r aY efe�F ek�F a4�e�e:F 9r�r 4e 4t 7F�c�k die�'e 3s do dr�'ex�e k 4e� -fir is*�c a'e�c ie' ie it iexie <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> �OAIICHECI�OFFLIST' �`�ss �rtProofreadreport?.� Correci�L:4ND'flSE#9 <br /> EH 05 ob Rev 199 � ' �Correet_CONDITID�Y{Sjn Logger!rn'LAND IJ3EBODK� <br /> N <br /> xy��, <br />