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Fi ec- U <br /> � vOTE: PULL ALL PERK,-,,S (SEPTIC, WELL, ETC...) 10KE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: Q COMPLETE & SUBMIT BY_A q h PAY- <br /> j l 1L9 <br /> DAT '�""DATt <br /> ATTN: J <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 V" Denial Continuance Inspector's Signatur <br /> drxdea�e�icde�Fir9r9c�rafrxicic�cdcaF�c9eK4eAex�rxx�e�e`Jc�e�c�F�cx�c$rdr�F9x$r�e�e��k�e�'ede9eek�eie*ieiricic�ci��risicicdcirir$c�c�kaFxde�'eic9ckick�c�cirK�'c�Fkxde�'c9c-Jq <br /> Supervisor/Lead Senior Comments: <br /> 6 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> O�II CHECK OFF LIProofread repori?': Correct LAND USE#? <br /> EH o�06 Rev i�g9 '.G"orrect:CONDITIOfY{S)� Logged rn LAND USE BOOKS <br />