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-k. .. ._._ ...-1 .. <br /> COTE: PULb--P . ._ S (SEPTIC, WELL, ETC R FL- <br /> LAND USE REPORT APP# O a - a <br /> EHD RECEIVED APP.REFERRAL: —711110 L COMPLETE & SUBMIT BY <br /> DArE ATE <br /> ATTN: s� <br /> SITE ADDRESS: <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 /> 194aw4.✓i� V e�71.11IJ A*x)-X4/ <br /> c r <br /> a� <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> x: n <br /> Z.. <br /> SUPERVISOR/LEAD SENIOR APPROVAL: = ' <br /> •- 4 <br /> .N <br /> r. <br /> OA II CHECK OFF LIST. Proofread report? Comtel L4"VP t S'E#? <br /> EH 06 06 Rev 1/99 "' Correct C(�.�`I)ITIO;Y(S)? Logged in L4:�"T) USE r),OO ? <br />