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NOTE: PULL ALL PERK j-- S (SEPTIC, WELL, ETC...)'ivrAKE COPIES FOR FILE <br /> LAND USE REPORT APP# q <br /> EHD RECEIVED APP.REFERRAL:1d�" ~� r COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN. ; An <br /> SITE ADDRESS: 7 g 7 + v <br /> � l <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 /> I recommend: ApprovalV Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHEEK OF .LIST Proofread report?�� Correct LAND USE <br /> s € 't Correct CONDITI()N(Sj gged in LAND USE BOOKS . <br /> EH 06 06 Rev 1199 + z <br />