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1� <br /> :NOTE: PULL ALL PERWTS (SEPTIC,WELL, ETC...) Ni*KE COPIES FOR FILE <br /> LAND USE REPORT APP# ( ) — j <br /> EHD RECEIVED APP.REFERRAL: d -I O �3 COMPLETE & SUBMIT BY *j7 <br /> DATE DATE <br /> ATTN: )1 a <br /> SITE ADDRESS: S <br /> In completing the Land Use investigation, draw all Public Health factors on the e Ibit(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: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> i <br /> ,r <br /> ' SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA !!CF/ECK OFFLIST: _Proofread report? _Correct L.91VD USE#? <br /> EH 06 06 Rev 1/99 <br /> Correct CONDITION(S)? Logged in LAND USE BOOK? <br />