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-ry <br /> NOTE: PULL ALL PE S (SEPTIC, WELL, ETC...) N .KE COPIES FOR FILE <br /> LAND USE REPORT APP# -a / <br /> EHD RECEIVED APP.REFERRAL: I A—0 COMPLETE & SUBMIT BY =,2 -/-3—d � <br /> DATE DATE <br /> ATTN: ge-An <br /> SITE ADDRESS: 13�r, q ��" 7-t lA <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit 0.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.... L <br /> Public water: �A Public sewage: <br /> SUMMARY OR COMMENTS: <br /> 6- A G <br /> Ds 4 <br /> r <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECKOFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />