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-NOTE: PULL ALL PER *riTS (SEPTIC, WELL, ETC...) .--AKE COPIES FOR FILE <br /> LAND USE REPORT APP# ; / - �� -e Q <br /> EHD RECEIVED APP.REFERRAL: - of -I q COMPLETE & SUBMIT BY C19DATE DATE <br /> ATTN: �<a i f�,ln„nr <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: /Voy e— Public sewage: /f/0�7 <br /> SUMMARY OR COMMENTS: <br /> o <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> is ir>r>iit*ic:kit ixx�F�czit irxic�cx icxic>t it ie iex is ic><icr.icx�i*ic is is is is>csx�c:F>ci<it ic:4xit Kit is ie xie xit is xir is itxic i<it ie is xic it ie ie st it*ie ie it�e�F air is icx <br /> Supervisor/Lead Senior Comments: <br /> nZL <br /> SUPERVISOR/LEAD SENIOR APPROVAL: �M <br /> — ,V, <br /> OA II CHECK OFF LIST: Proofread reportCorrect L,4ND USE 4? <br /> u6 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />