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1 NOTE:PKE COPIES FOR FILE <br /> ULL ALL PERM�.x S (SEPTIC, WELL, ETC...) 11 _ <br /> i <br /> LAND USE REPORT APP# L ,4 - -V <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BA <br /> DIM DATE <br /> ATTN: A/0 <br /> SITE ADDRESS: �,� ,n/. <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: 5 Public sewage: uj C 5 _ <br /> SUMMARY OR COMMENTS: <br /> 6 H ' 0 <br /> I recommend: Approval 'Denial Continuance Inspector's Signature 14 r <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: r o <br /> �;4A II CHECX OFFLIST Proofreaii report s t _'3 Correct LA1YD L7SE#' <br /> EH 06 05 Rev 199 ;;' �� Correct CUNDITl4N(S}?� �' Logged rn LAN USE BOOK7 . <br /> �`- '�;`...��zs�=is..�;k?::x ER??,3��;� �, -u'�:_:a..Rrn!.0 s�.f,,e.f4z •.wrir.� «..�:v� <br />