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t NOTE: PULL ALL PERI' ,S (SEPTIC, WELL, ETC...) P KE COPIES FOR FILE <br /> �. <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: I COMPLETE & SUBMIT BY6 - 11 -0-3 <br /> DA DATE <br /> ATTN: L --, <br /> SITE ADDRESS: A5y(o <br /> b % <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 /> (�� <br /> C l� <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �c�cicdc�'c*�4**�Y�c�F�cx�c-hicirir�kixic�FFc�'e9c9r9c9c�Y�cxic�F�F�4��'c�c�'c�cdcx��F*i'c�'c*�YoYic�c�F�Fic�F3cx�c�c�c�ciciciciciricxicicic�e�cicicxic�cxicieici�ic�F�Ficic <br /> Supervisor/Lead Senior Comments: <br /> V <br /> fir- /2 <br /> cc, 0-1- <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 />