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NOTE: PULL ALL PERNrr-t'S (SEPTIC, WELL, ETC...) IN,--vKE COPIES FOR FILE <br /> LAND USE REPORT APP# �� "D� ''�y (- <br /> EHD RECEIVED APP.REFERRAL: I Q�� -0 D- COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: q 29 Q _ <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: <br /> SUMMARY OR COMMENTS: <br /> \ 3 (J <br /> �Eevrr��E,v� [�Ei(1i�3� - 5EP7�c sysrF.Hs uui��:' �}�!",NRu�1'1�f'tl.!'S - I.o�.�tr�' •��,1�,,. <br /> !oV 5 7;4/4.4 D IV <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> xicx is is icxxx:c icx�k�cxic it icxxx�c�F 4cx>c ycx x�c>c*ic it ic>cx�cz9c icxxxx xxxic icxxicxxicxxicx is is r:is toxic 9cxxirx9c is�c�cx r.icx icx:c is is r.irxxic <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />