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T ! 1 <br /> DOTE: PULL ALL PEPM, S (SEPTIC, WELL, ETC...) 1,,AKE COPIES FOR FILE l <br /> LAND USE REPORT APP# Ph -QQ -1 a-?(Sl't) <br /> U <br /> EHD RECEIVED APP.REFERRAL: 1 -g-0 a COMPLETE & SUBMIT BY 5 --) —0 a <br /> DATE DATE <br /> ,,/I <br /> ATTN: ��nY1f _ !i yclle-r <br /> SITE AI%DRESS: -] 3(�Q KCI . s±&- <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 /> b <br /> i � <br /> t 5 <br /> 4092 U94 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> i <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA If CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1X99 Correct CONDITION(S)? _ Logged in LAND USE BOOK? <br />