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�B <br /> NOTE: PULL ALL PERF., _'S (SEPTIC, WELL, ETC...) �iKE COPIES FOR FILE <br /> LAND USE REPORT APP# S/9- C /- 7 3 <br /> EHD RECEIVED APP.REFERRAL: `� U� COMPLETE & SUBMIT BY — 7 — U a_ <br /> DATE DATE <br /> ATTN: 6� L r» L i-d4 <br /> �✓ � 14;? //fi�z <br /> SITE ADDRESS: U' i 7�' /✓ S ��YL/ �' L?' zed , <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: Approval Denial Continuance Inspector's Signature <br /> +*Kxxx+xxx**�*+xx*+*xx�*xx*�F�xxnxx,�*xxxx:�*x**xx*x***x*:�xx,�*xxx:�xx*xxxxxx�+xxxxxxxnxxK+xxK <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST.- Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rev 1/919 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />