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c)ri(- c /amu <br /> NOTE:, PULL ALL PERW"S SEPTIC, ULL9 ETC... P� yKE COPIES FOR ILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY_f—2—0 1 _ <br /> DATE DATE <br /> ATTN: <br /> SITE ADDRESS: <br /> In completing the Land Use investigation, draw all Public Health factors on the exh' it (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 <br /> C P — d 'e, <br /> i <br /> i <br /> � i <br /> I I recommend: Approval Denial Continuance Inspector's Signature <br /> C ' <br /> Supervisor/Lead Senior Comments: <br /> r <br /> , a <br /> j • a1 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> i <br /> OA tJ CHECK OFF .IST Prnojread report? Gorrect LAND[ISL#? <br /> EI-1 06 06 Rev v99 i � � Gorrect CONDITIOI V(S)P° Lnpged in LAND IISE BODK? F <br />