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Z-41 <br /> COTE: PULL ALL PE <br /> RN�,,.!S (SEPTIC, WELL, ETC-) NSE COPIES FOR FILE <br /> LAND USE REPORT APP# Pa _V/ 2 q 6z <br /> EHD RECEIVED APP.REFERRAL: of `02 ! `()Z COMPLETE & SUBMIT BY PVT <br /> DATE :,-4P-- <br /> XT"E a A <br /> ATTN: � <br /> SITE ADDRESS: ii ed <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: �z0 <br /> SUMMARY OR COMMENTS: <br /> i� <br /> I recommend: Approval ,-, Denial Continuance Inspecto 's atu e.e.—.� <br /> ��c�Eic�cde�';�t:ESE-k3cdex$tick$c�kaF:ti9r�ck�c�exx$t�Fvc3c*irx�r>e�r�c�icir$exx�cdcic�cdeJe�ciEick�F�e9cfrdcicick�t9tacdciciciex�r :Eicicx�'r$r�ck�c �kx�x�'c�cvk <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CIfECK QFF LIST Proofreurl report? ; Correct LAND USE# ,� k <br /> EH 06 06 Rev 1199 <br /> Co`rr`ect CQNDITION(S) ogged in LAND USE BORIC. . <br /> a�� <br />