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AIG <br /> S (SEPTIC, WELL, ETC...) N,AKE COPIES FOR FILE <br /> NOTE: PULL ALL PERIV�IT <br /> LAND USE REPORT APP# / <br /> / ®y <br /> EHD RECEIVEDAPP.REFERRAL: �� tl COMPLETE & SUBMIT BY ATE <br /> DATE // <br /> ATTN: Dv'/c <br /> SITE ADDRESS: 5 . Move <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 /> T`r � 2�s �!i✓srSZ G, C n4 f� -o4�t/ �txo Ga IH Ft�dL��f l ilhi / /A <br /> ,V/LLi n,�/tL�i�/YID KQF <br /> ,S/t�3G2®i / �U316t3 Z1EAzsiRru 2ti 4`�«�'� pw� � ft�C�l�h�'B9EL <br /> • �//����-✓/i�45!•/i.�3r LOU-Z�l/•e/ThErC�w�ci2l� —�> > <br /> i <br /> ,q I�t�FtckJ A��lu+.l7��lcv�itn-o.a-iQC1MP.ro�,— <br /> ��� <br /> G <br /> I recommend: Approval Denial Continuance Inspector's Signator <br /> Supervisor/Lead Senior Comments: <br /> Q <br /> IF WV <br /> OFF' 0 <br /> t OF /1 <br /> � • d <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST.- _proofread report? _Correct LAND USE#? <br /> Correct CONDITION(S)? _Logged in LAND USE BOOK? <br /> Ell06 06 Rev 1/99 <br />