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_S:s <br /> NOTE: PULL ALL PER I-t f S (SEPTIC, WELL, ETC—) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: - 1 9- ( COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: ,\c\ ` J <br /> SITE ADDRESS: Ct of (V,\j T <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 /> 9c rc�c icx*�cxic�c�ir�Fxix 3cxrc�c�c�Fn�c�c is it x�E icxicxxicK 9c icxxxic is�F is is�F is�F i� x irzicxicxxic i�icxicx i�ir is is is i�ic irxic is is is icxx�cxi�icxicx <br /> Supervisor/Lead enior Comments: <br /> u" <br /> 41W ', � r2 <br /> f�0,P A- O Y <br /> 1,22 <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> t <br /> OA H CHECK OFF LIST.• Proofread report? Correct LAND USE V <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />