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`23 <br /> ` NOTE: PULL ALL PERF (SEPTIC, WELL, ETC...) P, -E COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: D J1 COMPLETE & SUBMIT BY - ,3 -0-q- <br /> DATE DATE <br /> ATTN: �). � Jc)//e y <br /> SITE ADDRESS: �y�3 ,) <br /> ,re%c jeC/• <br /> i <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 /> z'cx9cxxx'cic9cie�ex�x'cieic'cic�F��c'cx'ca'cx*icxxxxx�'exic9cic�cxiricicxiricxicxxicxiricicxicicieicicicxicxxxxx'cieic�ciciaYxXicxxxxxicicxxX <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: ; <br /> 6 <br /> OA H CHECK OFF LIST.• Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />