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�m�irnK <br /> s <br /> NOTE: PULL ALL P*kAtrrS (SEPTIC, WELL, ETC.-.O.)) NrytKE COPIES FOR FILE <br /> LAND USE REPORT APP1 '04- -O 3 -0 a (S6) <br /> EHD RECEIVED APP.REFERRAL: 0COMPLETE & SUBMIT BY V 9 <br /> D E D <br /> AE <br /> ATTN: agxfR IWL7rGll �C' <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 /> ,n43 Sea <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> Oil II CFIs` $ Fraofreorrt h, Core T fS�D TSE <br /> EH 06 06 Rev 1199 �i+' '� Eoly�Cl C011XTD�t'� O$g�ei1 4ND `E��©1C <br />