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NOTE: PULL ALL PERNVr--NS (SEPTIC, WELL, ETC...) N' E COPIES FOR FILE <br /> LAND USE REPORT APP# � <br /> � <br /> EHD RECEIVED APP.REFERRAL: 2—3 1 —`�j <br /> Z COMPLETE & SUBMIT BY <br /> DATE / DATE <br /> ATTN: 1� I -,i` f�1 <br /> SITE ADDRESS: s (D • <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 /> M <br /> I recommend: Approval `� Denial Continuance Inspector's Sign <br /> arxac*ia*****ems**** see 9c 9e eFxie**$e it*x$ <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> ��04 II'CIIEe. Opt LIST -Pro`afread report �' :;`r Carrect LAI!'D USE#? <br /> Correct CONDITIONS ? r �TLo ed in Lf1ND USE BQOXa <br /> FH 06 06 Rev 1199 l �$ <br />