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NOT E: PULL ALL PERT,,_,TS (SEPTIC, WELL, ETC...)-,AKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: i�IZI03 COMPLETE & SUBMIT BY / ,_,7 q -6� <br /> DA7E <br /> / DATE <br /> ATTN: � 4,/\� M I Yl j�1� <br /> SITE ADDRESS: � C, /J , 5 �' q 9 e- <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 Le 3 Zo 2 yj �°z dejtars r 6 3 ctw- , --�— <br /> e s <br /> nApprova�l <br /> / i1/ 1(/)a! USE' G. 5 � �� fr Z/ � <br /> recommenDenial Continuance Inspector's Signatut'e`X)CX X?CXSupervisor/ ents: <br /> �4 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />