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NOTE: PULL ALL PERl1fS (SEPTIC, WELL, ETC...) : -,,I,KE COPIES FOR FILE <br /> LAND USE REPORT APP# , �' -(o <br /> EHD RECEIVED APP.REFERRAL: ' f - COMPLETE & SUBMIT BY rj _` — 0 <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: CJr 35 (� ^�� � Lc � <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 /> '1Z� a��► Sr o) -as' <br /> C7(� sX2 ' <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> do is a'cx�F 9c irxxicxxxic is icxxic is icx>c xic is is�c 9cxxic is icx icxx�c icxx�c r,is icvxxic is icxxxxic icZcxic is is is is x�c�cxxic is is xic ix xic icxxic r.>c�icxr.it>c <br /> Supervisor/Lead Senior Comments: <br /> Z tom- a` ��✓ r� - / <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />