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Td <br /> NOTE: PULL ALL PERK ti S (SEPTIC, WELL, ETC...) P_,,,KE COPIES FOR FILE <br /> LAND USE REPORT APP# SU - 01- 1 <br /> EHD RECEIVED APP.REFERRAL: )Z-O q -D I COMPLETE & SUBMIT BY ! J CII <br /> DATE DAIM <br /> ATTN: 7E F F 1= 1 S ii i=e <br /> SITE ADDRESS: )is-61 F J A H A NT 2b . , AC A H P('1 <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 /> //. al <br /> 03 <br /> 1 <br /> e. <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> OQ OQ <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 _Correct CONDITION(S)? Logged in LAND USE BOOK? <br /> I <br />