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NOTE. PULL ALL PERI, -.?tS (SEPTIC, WELL, ETC...)--i,,1AKE COPIES FOR FILE <br /> LAND USE REPORT App# `0 _a <br /> EHD RECEIVED APP.REFERRAL: `7 'o l COMPLETE & SUBMIT BY IiS O(' 41- q-a1 <br /> DATEE DATE <br /> ' ATTN: eN I <br /> SITE ADDRESS: S f s- <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 reap of area <br /> showing population density, location of house, wired direction, etc.... <br /> Public water: Public sewage: " <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signatu <br /> ****9cdr:F*�tit9e**k�e*�Irte�clr*3e*�e�tlr*kia*�eJe�c*:Eic*Fati:ir9eeeFv4*Ir**9e*Fe49r�r�c*vEic�r�rdeiexc**ieicx** * dek�e* xir't>e*ir�reiex <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> SOA 11 CHECK UFFL�ST Praofread report? - 'Corred LAND_USE#� <br /> EH 06 06 Rev 1199 ° r ' <br /> Correet CONDITI4�V{Sj7 Logged in' <br /> )AND USE BOOK? <br />