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1 <br /> NOTE: PULL .ALL PERS fS (SEPTIC, WELL, ETC...) IW4KE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: lJ COMPLETE & SUBMIT BY —� <br /> DATE DATE <br /> ATTN: [D.La <br /> � <br /> SITE ADDRESS: 5�Q <br /> disposal <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit(i.e.: sewagep oral <br /> , <br /> +�, „�, e;o� .�+. 1 t�Il�pro nrraccary nn n_attached niece cif nlain_naner, draw completed map of area <br /> i a"a a erDi3U-b vmg <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �E4e*x�F$:ie9e�c9ck�F9c4tx,9ex�e�r9c9e�c�c�i�c>t�t��e�ra�cicicdck�'t�e�edr�Yk3c!c$c4c9edriek�rxicvkic3cocdcisxxxxicxiricaEkieiede�Fie�c3cvFrt9eieieivieic$t�tdeiexie3c <br /> Supervisor/Lead Senior Comments: <br /> t � q <br /> rVL.r a - <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST; _ `Proofread report� is � Correct LAND USE#9 <br /> EH 06 06 Rev 1199 r' u .Gortect CONDITION{S) Logged in LAND USE BQ()Kry <br />