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,,-N,QTEc ' <br /> PULL ALL PEW` (SEPTIC, WELL, ETC...) ` E COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: !a-a{-al COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN: U 14/) <br /> SITE ADDRESS: 5 q 1 S (I t- <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: *10, Public sewage: tit <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> 0,6 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> CFrEC 4F.F�IS7'� _. Proofread report? �' Correct,C,4ND USE#? , <br /> � 'Cdrr ctCONDITION(S}?° LoggedinLANDUSEBOOK? ' <br /> EH 06 Db Rev 1199 K. <br />