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NOTE: PULL ALL PERN6iS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE a <br /> i <br /> V <br /> LAND USE REPORT APP# 4- <br /> 6r <br /> EHD RECEIVED APP.REFERRAL: I q ! COMPLETE & SUBMIT BY�-514r,�} 1—,2 —d' 9 <br /> DATE DATE <br /> ATTN: Urv, V U�e <br /> SITE ADDRESS: IS ue i2; �n <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, ocation of house, wind direction, etc.... <br /> ,ff,--- <br /> ru <br /> blic water: Public sewage: <br /> SUMMARY OR COMMENTS- <br /> I recommend: Approva Denial Continuance Inspector's Signat—L4*#4 <br /> ure <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> DA II CFIECK aFF LIST:. r :;Proofread report Correct I4ND USE#9 <br /> Correct COIVDITl01�(S)9 dogged rnSAND[ISE BC4K� <br /> EFI 06 06 Rev 1199 E <br />