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NOTE: PULL ALL PER1V —S (SEPTIC, WELL, ETC...) P KE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: "� COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: y(�,j cJ ej C�j <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 /> I recommend: Approval Denial Continuance Inspector's SignatureA�zL-i <br /> xaY*ic'x c irxxic icx 'x c icxdex�exxicxxixxxxxx'x F is c is icxxx�c icxzic icxxir�cxsc is is icxxF is is is icxxxic is c is is icxir 3e aye�t 7tt 7tx7'C a'c '3e YX9e <br /> Supervisor/Lead Senior Comments: <br /> oy <br /> SUPERVISORIL.EAD SENIOR APPROVAL: <br /> OA 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 />