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NOTE: PULL ALL PERI1 tTS (SEPTIC, WELL, ETC...) X KE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EIID RECEIVED APP.REFERRAL- r COMPLETE & SUBMIT BY A P■+RYO `3 �3 <br /> DA DAT k <br /> ATTN: Vii. dl ()�e-ll ffl. <br /> SITE ADDRESS: <br /> In completing the Land Use investigation,draw all Public Health factors on the exhi rt (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 /> 0,0 1 . <br /> I recommend: Approval Denial Continuance Inspector's Sign <br /> $eie$cir�F:E$efk�t�F�$ekieieir�Y�rjc�c�cie�k9rx*de$c*aF$k3c�cisicx$r�ekx�cic-.'e�c3cde$rde�c�t9ek�r�eJeeFak�r*ix$eir3cos�e!r�' x�e�Jr 3c!c�9e9rxx*de 9cic�cdc�t>e <br /> Supervisor/Lead Senior Comments: <br /> f <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> (7iI'°II CHECK UFF,LIST � -P.0.0 rim cepa Correct LAND USE#' <br /> " Correct CO DIT101V{SJ7� Lvgeed lW LA IVi&SE BL7DK� <br /> EH 06 06 Rev 1199 y� - <br />