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a <br /> NOTE: PULL ALL P S (SEPTIC,SEPTIC,WELL, ETC•••) M—AE COPIES FOR FILE <br /> -4-L <br /> LAND USE REPORT <br /> APP# S <br /> - d COMPLETE & SUBMIT BY <br /> EHD RECEIVED APP.REFERRAL: DATE <br /> DA E <br /> ATTN: <br /> SITE ADDRESS: <br /> In completing the Land Use investigation, draw ail Public Health f Icc ors on <br /> the ex <br /> it (i.e comewage pleted map disposal,area <br /> water supplies, etc...). Where necessary, on an attached piece of Plain paper, <br /> showing population density, location of house,wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> , Q <br /> 14 <br /> Ins ector's Signatur 1116I recommend: Approval _ <br /> Denial Continuance P <br /> ***ie**Icx*ie*k*4*********Tr****ix****dr******ie it*********ir******ir*x**ir eF**'lc ar*****•�***ie*de******4r it* <br /> Supervisor/Lead Senior Comments: <br /> Of <br /> o o _ <br /> 4.0 <br /> 4 �I <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> 3 � Correet <br /> OA II CHECK <br /> Correct CONDITION{S) orged.in LA1VD USE BOUH? <br /> EH 06 06 Rev 1199 <br />