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t� <br /> v NCIft: PULL ALL PERl��fS (SEPTIC, WELL, ETC...) KE COPIES FOR FILE <br /> -A <br /> Z' <br /> LAND USE REPORT APP# L -0 � _S <br /> EHD RECEIVED APP.REFERRAL: - a 3-Q, COMPLETE & SUBMI , b�A ��to <br /> DATE bA <br /> ATTN: Je <br /> SITE ADDRESS: g F D 7 s <br /> In completing the Land Use investigation, draw all Public Hea th 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: e22�6 Public sewage: <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approva Denial Continuance Inspector's Sign e <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> �_dA II C�1 ECK OFF L�S'T �� �Proofread report? � Correct LAND I/S'E#?`��� <br /> EH 05 ob Rei 1149 ;� � � � Cvrreet C0IVDITION(S}Pay :;'°jogged rn,:4 USE BOOR? <br /> r <br />