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LC <br /> a NOTE:' PULL ALL PERI S (SEPTIC, WELL, ETC—) l KE COPIES FOR FILE <br /> I <br /> LAND USE REPORT APP#- <br /> � <br /> y . <br /> EHB RECEIVED APP.REFERRAL:-�Z3 ooCOMPLETE & SUBMIT BY 54f ���`oa <br /> DAT <br /> DATE <br /> ATTN: r N1i� Gz Gi <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 /> I recommend: Approval Denial Continuance Inspector's Signat <br /> JY— <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK QFFLISTProofread report? 3' Correct LAND USE#9 <br /> EH 06 06 Rev 1/49Correct CONDITIONS}� `a ".Logged in'LAND USEIlOOK? � <br />