Laserfiche WebLink
T- NOTE: <br /> M�ECOPIES FUR FILE <br /> PULL ALL PER.NX (SEPTIC, WELL, ETC...)f � <br /> APP# l r JS <br /> LAND USE REPORT -' <br /> -( COMPLETE & SUBMIT BY DATE <br /> EHD RECEIVED APP.REFERRAL; DATE <br /> ATTN• <br /> SITE ADDRESS' <br /> Use investigation, draw all Pu Ic Health factors on theexhibit pleted map of area al, r <br /> In completing the Land on an attached piece of plain paper, draw <br /> water supplies, etc...)- Where necessary,of ouse,wind direction,etc...... <br /> showing population density, location � , <br /> Public sewage: <br /> Public water: <br /> SUMMARY OR COMMENTS* <br /> yt <br /> 4 <br /> v b <br /> Q lC� ci cC e a <br /> K <br /> 10 ' <br /> i S In, d <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> e <br /> J <br /> F ✓1/u�-� <br /> L-i <br /> SUPERVISORILEAD SENIOR APPROVAL: - <br /> OrA.II CHECK ElFF LIST Proofread reporta Correct LAND USE#9 ` <br /> EH 06 06 Rev 1/99 OR Correct C4NDITI4N(S�p °Logged rn LAND USE BOOX� <br /> c s�4-:�a1 �.2: ,,'ta.:. .�u'4'.fi✓,�..- ¢s.k'�,=.. .r. �.x,. ��:.sy, .�-�.-�,a .`�d>a. �'°a4^' wS-t`":,N�i g'r'�:....,.o^x« <br />