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LI�� <br /> NOTE: PULL ALL PER TS (SEPTIC, WELL, ETC...) ,SAKE COPIES FOR FILE <br /> LAND USE REPORT APP# eA `f <br /> EHD RECEIVED APP.REFERRAL:_L7 —0 'J_ COMPLETE & SUBMIT BY - 2 t — L 3 <br /> DATE <br /> ` DATE <br /> ATTN: <br /> SITE ADDRESS: a <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: , „s,, Public sewage: . F cp r i <br /> SUMMARY OR COMMENTS: <br /> ao:of <br /> I recommend: Approval Denial Continuance Inspector's ign <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 77 CHECK OF 'LIST: _Proofread report? Correct LAND USEV <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />