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Z <br /> NOTE: PULL ALL PERT,44w,I'S (SEPTIC, WELL, ETC...) i�,KE COPIES FOR FILE <br /> LAND USE REPORT APP# - a <br /> EHD RECEIVED APP.REFERRAL: 1- - I 1 `V 2— COMPLETE & SUBMIT <br /> DATE DATE <br /> ATTN: _K /til ( , <br /> SITE ADDRESS: 1010 ) <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 /> I recommend: Approval Denial Continuance Inspector's Signature~' <br /> *icxxxzic 4c icx�c>c icx is is�'c'xxicxx�cxic�c is is is icx�c�c r.i�>c>c>c icxxxxic is icxx�c:c�Fxxicxxic is is icxzxx �ic isxis icxicYx�r.:cif.r.xxr.r.x>c�..is is <br /> Supervisor/Lead Senior Comments: <br /> J . Y/-107 <br /> a <br /> b <br /> s '�'�,-.4r'L.`►� tc° �'''��:is::ral p a �'?r c_. :s.�: <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 />