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jy <br /> NOTE: PULL ALL PERNVrrfS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: q-3 -01 COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: �—,eg-,nn e VYl U PL(p.r <br /> SITE ADDRESS: � 7 I , luy �— S f- ✓e -Cl oc k h--1 <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 /> W IV-14 <br /> I recommend: Approval Denial Continuance Inspector's Signature 44=4--V� <br /> �F�Fxix�r�c�Y 9cxrc*�'c�c i��t*xxic*x�c is�r is irx�k is 9c�F is 9c hex**9c�c*�exx�c�c�t*z�k�c i�x�'c do irx9c�F�c�'c is is 9c�ic it icxic is�c�i is r'e �t tir dt alt�lr 7� 'k�e�t$e 9t it <br /> Supervisor/Lead Senior Comments: <br /> © y <br /> /1, 0 ( <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> Ori 11 CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />