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NOTE: PULL ALL PERA# (SEPTIC, WELL, ETC...) *E COPIES FOR FILE <br /> 0 <br /> LAND USE REPORT APP# �— C TE <br /> EHD RECEIVED APP.REFERRAL: +�3 COMPLETE & SUBMIT BY / ' C� -01 <br /> DATE DATE <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 /> I recommend: Approval Denial Continuance Inspector's Signature <br /> iciricicFicicicic'eeie�e9cieiricicx'c�r�ca'c�r�r'crricx�Y�c4cF9cieF'c'c�c*ic�c4a'c�r�c��c9ricicicix�cicicicieXicXicicxx*xxxxx�cxx�czxxzxxxx�ricir�cir <br /> Supervisor/Lead Senior Comments: <br /> ��t'T✓I rtiY./ �C�i4�✓VL//`f I �+'L� li►'"�'�l'i.d'�' / ��� J'' ' ,� q, > <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <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 />