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7-r <br /> 14 NOTE: PULL ALL PER' ITS (SEPTIC, WELL, ETC..., LAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL:D T 09 COMPLETE & SUBMIT BY <br /> LDATEN: �?Ct� <br /> SITE ADDRESS: Q <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: ,/V✓ Public sewage: .✓� <br /> SUMMARY OR COMMENTS: <br /> :�rlf- 104 1AA1" <br /> arm - rwks-_. <br /> I recommend: Approval Denial Continuance Inspector's Signat <br /> rre <br /> **�t****ziri�ix>e**xk�c**F�c*FkxaF�'t*ire*�r*xic*�c9cicieic�e3t**k***eF*�c3ck*4c*:Fa'cit*�cx*�'t**�r�e9cAc*,cFxxx <br /> x <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OAIICHECK'OF ,LS� _� `.' Proofrer�drepvr�P 'L~arreet4VDUSE <br /> #9 <br /> EH 06 06 Rev 1199 x, z DI�I . <br /> k a , Correct CON ON(SJ7 ; , Sed in LAND USE B001Y9' <br />