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t <br /> NOTE: PULL ALL PEIV YS (SEPTIC, WELL, ETC...) TAKE COPIES FOR FILE <br /> f�p na� <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY <br /> DATE DRAT <br /> ATTN: <br /> SITE ADDRESS: G <br /> In completing the Land Use investigation, draw all Public Health factors on the ex 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 /> �. ��� �°� ..►tire �,�� � /�,�o,/ tco.Q �w2V <br /> C <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> icx xxic�c�c�c�c is 3cxXxxzzsc is�c�c 7cxxicxx�e�cxic�F�cxx>c is is is�c is is it is�c�c is is isxis is icYxicx�Fx�cxicnic icx�F�c:'c*�cnic;cxic icxzziczicxx>c isxicx <br /> Supervisor/Lead Senior Comments: <br /> A4Lo-U p6--c� 44 f; a Zyw� S4� y4- <br /> ts►+.%� <br /> f� , <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 />