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NOTE: PULL ALL PERPnTS (SEPTIC, WELL, ETC...) SAKE COPIES FOR FILE <br /> LAND USE REPORT <br /> 1I <br /> EHD RECEIVED APP.REFERRAL: Z Q3 COMPLETE & SUBMIT BY o2/�e <br /> DATE <br /> ATTN• <br /> SITE ADDRESS: 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 /> 6 - � <br /> ,4 -/ . 0 <br /> .oma <br /> ; � 3 �► <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> ; 0 � <br /> SUPERVISOR/LEAD SENIOR APPROVAL: - <br /> OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> Ef10606Rev I/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />