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yy4 <br /> NOTE: PULL ALL PERN1irfS (SEPTIC, WELL, ETC...) N.,.-EKE COPIES FOR FILE <br /> LAND USE REPORT APPA �ZIILO <br /> W?6419) <br /> TV mss. <br /> EHB RECEIVER Ali.REFERRAL: �' COMPLETE & SUBMIT B <br /> DAT �, DATE <br /> ATTN: � v n <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 {Si a8 <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA Il CHECK OFFLIST .<,,Proofread report? Correct LAND USE#? <br /> 171]06 06 Rev 1199 � �'; x =< Correct CONDITIONS)7! � 7 <br /> �L.6 ged in'LAND'USE BCIO$ <br /> f.� <br /> ..� �. <br />