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Z_G <br /> ,01, C: PULL ALL PERI, _'S (SEPTIC, WELL, ETC...) _ XKE COPIES FOR FILE <br /> LAND USE REPORT APP# 1'4 -Q S 6,4) <br /> EHD RECEIVED APP.REFERPUL) J _a -00't COMPLETE & SUBMIT BY <br /> DATE <br /> '���,,nn DATE <br /> ATTN: �e G t�11 u � ►v IIP � <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 /> 00, <br /> I recommend: Approval /Y_ <br /> Denial Continuance Inspector's Signal <br /> ��c*xXx'c*icicxxicie�c'cc9c7cxicic4cxxxic9cF�c�cai�cic'cx9r*�c'c'c�c*F9eic'c�cir�cx*s'c'c�rirxcrix�c�cxx9cdc�ci('e'ikF�c�c4c �cxxicicF9cicxiciciriric <br /> Supervisor/Lead Senior Comments: <br /> d <br /> tA;t <br /> Q. • n i' <br /> w b <br /> SUPERVISOR/LEAD SENIOR APPROVAL- <br /> OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 •Z ' ��) Correct CONDITION(S)? P Logged in LAND USE BOOK? <br />