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s M <br /> " <br /> NOTE: PULL ALL PE ; <br /> R.,,.aTS (SEPTIC, WELL, ETC...) SAKE COPIES FOR FILE <br /> LAND USE REPORT APP# — — - O cP <br /> EHD RECEIVED APP.REFERRAL:121,)(4102— COMPLETE & SUBMIT BY <br /> D E <br /> ATTN: D E <br /> SITE ADDRESS: <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 /> 6'�/ <br /> la=d c - . <br /> i <br /> I recommend: Approval Denial Continuance Inspector'si ur �j" <br /> �Eicxicx�c�exxxxx�rxXxi�r�Ficxzx>cXirisicx�cisF'cicscicxic*xxx�c'xxicicixiiricxxicicicscxzKicx�Fic*;FFrcKic�c�cirxir�cicxx�c'�t e�coF$r�t7it�t�c <br /> Supervisor/Lead Senior Comments: <br /> �0 . <br /> W 0-7-4 <br /> o� <br /> C.. 2o ; D <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECKOFF LIST: Proofread report? Correct LAND USE#? <br /> EF106 06 Rev 1/99 Correct CONDITIONS)? Logged in LAND USE BOOK? <br />