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NOTE: PULL ALL PERl1 ZS (SEPTIC, WELL, ETC...) 1" KE COPIES FOR FILE <br /> LAND USE REPORT .APP# <br /> EHD RECEIVED APP.REFERRAL: a"! a COMPLETE & SUBMIT BY —BY- <br /> DATE ASAP/� rr DATE <br /> ATTN: k b 1e,,n ej <br /> SITE ADDRESS: ';�6 -?Q I S 0-,0C-rc•.( ���� (�J, <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 <br /> ewage-SUMMARY OR COMMENTS: <br /> i <br /> i <br /> i <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> nF�k�'e�r�'e�e9e$ctk��Ek�ek�c�r�F�r�*drkdex�r�ex�'ek4e�c$aE$raFdede�E!e�Fde$ckieisds�x�r�'rnk9:ieiticK�kir9cde$exp'cis3t�kicis9rita'ckeFis�Fis$ex�exx�'t�sK�e�cdszEac <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA 11 CHEC`IC OFF LIST - ProoJrearl report? Cor�ecl L.9N6USE# <br /> EH 06 06 Rev �/s9 ` �' Correct CONpITION(SJ? Lagged est LAND USE BD(3K� <br />