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NOTE: PULL ALL PER:'TS (SEPTIC, WELL, ETC...) --AKE COPIES FOR FILE <br /> LAND USE REPORT APP# 3 F �Sr4 <br /> EHD RECEIVED APP.REFERRAL:i ;� -3!0 oz- COMPLETE & SUBMIT BY /5 - Q 3 <br /> DAT <br /> ATTN: <br /> M A r n DATE <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: iX <br /> SUMMARY OR COMMENTS: <br /> oy <br /> I recommend: Approval Denial Continuance Inspector's t rEc <br /> �f X1CX>CX%ACX XJC JCJC)CX)C)CXY�CXXXXX�C X>C]CYXX)CXXX)C JCXX�XX:CXX:KXXX)CXKXX)CXX�CXJCXXiCX)CX X%]C)C �'cx�'c itx�c�F 4c �E�c 4c icxic is 4ex <br /> Supervisor/Lead Senior Comments: <br /> ,:jt <br /> CA <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />