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SS <br /> "NOTE: PULL ALL PERT �I'S (SEPTIC, WELL, ETC—),--AKE COPIES FOR FILE <br /> LAND USE REPORT APP# Q 1 -8 <br /> EHD RECEIVED APP.REFERRAL: - '�6`01 COMPLETE & SUBMIT BY-,j -a.0—C7 <br /> DATE DATE <br /> ATTN: <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 /> a:v <br /> (td3 <br /> I recommend: Approval Z"' Denial Continuance Inspector's Signature / <br /> Supervisor/Leadenior Comments: <br /> 144plipliF <br /> 001i no 0 <br /> / i <br /> 50W <br /> f <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST 8 :Proofread report?" Correct LAND USE#9 <br /> EH 05 06 Etev 1/99 A Correct CONDITIONM} Logged hi LAND USE BOOK? <br /> �. <br />