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Nd TJEi PULL ALL PEIV. SEPTIC WELL ETC... 'EKE COPIES FOR FILE <br /> ' LAND USE REPORT APP# -of -q5(7E) <br /> 6 <br /> EHD RECEIVED APP.REFERRAL- &//,Z/03 COMPLETE & SUBMIT BY A A P—RY, q1, 3 <br /> DA -DAYE <br /> ATTN: j 0S-2-FO6 ia.l g�S <br /> SITE ADDRESS: 1 . a ►��S , �S D rA -- <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 /> - k��eJe�e�+e�rt'ee'c�F>cdc�F�ciadcdcac-Jcic�ckaFsr�2iriricia�i�Fisi��r�ricdca4�r�'c�kdcxx�FvexlcaF�ek�r4e�lt�c�E�cdc�Ficicicic�'s$c-hdck3cicaEic*dc iv do 3c�FdcdcdcaE�kdc$sdc�FvFoEvF <br /> Supervisor/Lead Senior Comments: <br /> :j <br /> F <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF`LIST '' Proofread report Correct LAND USE#9 <br /> EH 66 06 Rev 1199 € `�'Correct C_ ONDITTUN(Sj ... Lagged xn LAND USEBOOK? ° '`' <br />