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ale <br /> NOTIL: PULL ALL PERAT&-f S (SEPTIC, WELL, ETC...) 1N-t.*:KE COPIES FOR FILE <br /> LAND USE REPORT APP# /`' C'-3 -ia <br /> -5�)- <br /> EHD RECEIVED APP.REFERRAL: Vj COMPLETE & SUBMIT BY // 2/a� <br /> D E DAA <br /> jo <br /> SITE ADDRESS: ,5 1 2 <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 /> A42e--2-s Zc � �,��i���/ ���s��� �� ��� r'z ,a-k.r>7s <br /> I recommend: Approval ,/ Denial Continuance Inspector's Signatu <br /> ix�c�c is 9c�F is*icx�c i�xx�F�cxx�'c it F ac it irxicxicxxic icxicx ixxr'r�c�Fxicxicxrcxxxzx�cxxxxicxicxxic dcx9c icxxic is i��c�kxic icxicxxxic is is�c icxicx <br /> Supervisor/Le�a/d Senior Comments: <br /> O��K�/ a•�t �t c� <br /> C . aIL 3 <br /> � :dui v' ✓ <br /> 12 <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 />