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�1 ` L-IV\- <br /> NOTA: PULL ALL PERIl�.-. (SEPTIC, WELL, ETC...) I KE COPIES FOR FILE <br /> LAND USE REPORT APPM_AqAP.Bvv <br /> EHD RECEIVED APP.REFERRAL. I COMPLETE & SUBMIT BY l v oI <br /> DATE <br /> ATTN:DE �C)�. !an es <br /> SITE ADDRESS: q -5-79 3, <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: --2� <br /> SUMMARY OR COMMENTS: <br /> f <br /> I recommend: Approval_Z Denial Continuance Inspector's Sign ur <br /> Supervisor/Lead Senior Comments: <br /> 8 1� <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK"OFF,LIST: Proofread report? Correct LAND USE# <br /> r° a f �Correct CONDITIDA(S)-� „ Lagged in LAND USE BOOK? <br /> EH 06 06 Rev k194 � �. - f <br />