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h _ <br /> ,L6 <br /> ' NOTE: PULL ALL PERK "S {SEPTIC, WELL, ETC...} IKE COPIES FOR FILE <br /> LAND USE REPORT APP# S - <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY — —6 ' <br /> DATE DATE <br /> ATTN: V <br /> SITE ADDRESS: s S Tu 1 <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: fri v ikt L, Public sewage: L <br /> SUMMARY OR COMMENTS: <br /> PE7 t �- 3 <br /> % 0 ( e n. <br /> 22 ' v 2. <br /> I recommend: Approval�Denial Continuance Inspector's Signature <br /> $t 4c 9c9e$r9c74�ek�ir�'edrdek�c�'rir�k$vkvFa�c�kiir�r9e�*$r�c9e�e�r�rdrde�e�cdrvFak�F�ka�e*4e�lr*�rle�e�eekdc�r�c9r$r*iririe�F�kaF�'c$rsir�r�eiededrdeek3ca'evFieic3 F9edr�r�e�Fa�e�k <br /> Supervisor/Lead Senior Comments: <br /> Q <br /> a : a� <br /> �C . 9211-03 <br /> ;aa- 6 1 - e r <br /> r a 3 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF,LIST Proofread report? Correct LAND USE#?x <br /> s -Correct CONDITION(S)'? Lagged in LAND USE BOOK? <br /> EH 0606 Rev 1/99 ;� . <br /> �� - r <br />