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NO'S'E: PULL ALL PERK rrS (SEPTIC, WELL, ETC...) &h-e" COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: 2 Z_ COMPLETE & SUBMIT BY v <br /> DAT I DATE <br /> ATTN: VE L-- �j � l `e- /- <br /> SITE ADDRESS: �L I a F-, tn )aJgdo-) K� `6" �K <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 /> Supervisor/Lead Senior Comments: <br /> ly�-t <br /> V VV <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rev irov 11 Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />