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�Z f <br /> NOTE: PULL ALL PERN'1Yl TS (SEPTIC, WELL, ETC...) IVB- KE COPIES FOR FILE <br /> LAND USE REPORT APP# 0,5 - /lY� J _ <br /> .LL ' 01 <br /> � . <br /> EHB RECEIVED APP.REFERRAL: S COMPLETE & SUBMIT BY 4 <br /> DA L DA rE <br /> ATTN: <br /> JO&Y4� <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 /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �t'c�r�c9eia�Fk3ckEkdc9:�e�e�cvk�'e�$ckdcicdsir�i�.c�Jricisicisicdr9t9r�Y�c$e�riric*�c3ckaFacds�c'tis9e�r�cdc$e*icxirxk�dc>c3e'cx�eicicdckaf�e�e�edeJeic�cka��ekk <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> SOA II CHECK OFF LIST. Proofread report i Correct LAND OSE 0 <br /> EH 06 06 Rev 1199 <br /> ` � Correct CONDITIO�Y(S} Lagged to LAND USF BOQK. ; <br />