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:f <br /> d: <br /> NOTE: PULL ALL PERIS (SEPTIC, WELL, ETC...) I KE COPIES FOR FILE <br /> LAND USE REPORT APP# �2-- `Z--14i <br /> EHD RECEIVED APP.REFERRAL: <br /> COMPLETE & SUBMIT BY 4S IV '�Vice <br /> DATE DATE <br /> ATTN: <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 /> !o /-o 7— P id--;>e r M�- /�Ao OU cnr-M,A-z -Vaww A 6., j�r kms <br /> AC�2- os,4 41,0.1� .40 ev I nr*, p*e/ls ,-t jol kj <br /> 4 <br /> 5 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �e ale�e�e�r elr>e�ex$t�e nF�k�F dck3c de aF�c afc�r aF it�r�c 4r�F i��r it de kir�e ie kir drxxdr�cxdc afr 3e 4r ie ir�4cx*x��e 9e�r�e 9e 9e*fie k9e le�4e�e*fie�exxie x4e&9r 4r�Irk$e is�ex4e 4t s4 <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> UA I�CHFC°K OFF LIST Praofreaaf repot!? ' .� : Correct LAND TISE'#9 <br /> EH 06 06 Rev 1199 3�` Or, CONDIT7DN(SJ? v edin LAND XTSE BOf)K9 <br />