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tT-L PULL ALL PER' - -S (SEPTIC, WELL, ETC... KE C <br /> OPIES FOR FILE <br /> LAND USE REPORT App# 4--�t�C � <br /> EHD RECEIVED APP.REFERRAL: C� �� COMPLETE & SUBMIT BY 1-5-1, <br /> DAT <br /> DATt <br /> ATTN: <br /> SITE ADDRESS: j SS <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 /> 9e�c*�c 9c is�e�'c io��c�'cxic is Xicx�c�c is is is is is is is�e 9e*xxicxic is acx3e icxx�c ac is icx�F�E is�E is�c 3e 9cxic�c iex�e ie o'c de�'ek�e*�'c�c,Ea'c�'C�e is is is is�r is�cxie�F�Fxic�c�c is <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: AiEE <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />