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/\f4:�, <br /> NOTE: PULL ALL PER,'-riTS (SEPTIC, WELL, ETC...) ...AKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: b COMPLETE & SUBMIT BY (a <br /> DATE DATE <br /> ATTN: )p <br /> SITE ADDRESS: T O <br /> In completing the Land Use investigation, draw all Public Health lactors 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 Signature <br /> i'e�c�e 3e�'c�'e�cxyc:kx�cx�c icx4c*dc�e*x�c�e ie iex4e 7e�c�c is�cxxx9cx�Y�e is�c 9c�F�'c 9c�Y�c 9c 3c�Y 4c�F�c�'c�c�e 4e>c�F�exrex�e 9e*�c�e�e�e 9c�c�e 9e 4e�e 9e ien�e is ie is�c icxxdex <br /> Supervisor/Lead Senior Comments: <br /> �aOr .' <br /> 0 � <br /> SUPERVISOR/LEAD SENIOR APPROVAL: 1 <br /> OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />