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NOTE: PULL ALL PERl.'TS (SEPTIC, WELL, ETC...) ;AKE COPIES FOR FILE <br /> LAND USE REPORT APP# 04 <br /> EHD RECEIVED APP.REFERRAL:I Qo2 COMPLETE & SUBMIT BY 1 - 91 - 03 <br /> DATE <br /> DATE <br /> ATTN: <br /> SITE ADDRESS: T(/ /6 1-,9 ri . <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 Signature <br /> xx�c�c icxx x>c aFx�cxx�c is�cxx 'x�c xic�c sx icx�cxxic icxic�c icx k�c�c�cxxx�F it�c�Fx�c ix�c is icxx'x�c icx�cxic is�c�cx�F�c icxx9c�c�k/��'c a'c*fit a'c�'c 9c 7F�(t�c�c*9cxx <br /> Supervisor/Lead Se for Comments: ° ��. <br /> OL <br /> Q y <br /> C. o <br /> SUPERVISORILEAD SENIOR APPROVAL: <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 />