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NOTE: PULL. ALL PERN�(SEPTIC, WELL, ETC...) :E COPIES FOR FILE <br /> 1' <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: �" I COMPLETE & SUBMIT BY ;!VAP <br /> —RY1 O o <br /> DATE x1T <br /> ATTN: <br /> r _ ,� `2 d OLS✓ <br /> SITE ADDRESS: � <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit (i.e.: sewage disposal, <br /> water supplies, etc...).s Where necessary, on an attached piece of plain paper, draw completed map of area <br /> showing population density, cati of house, wind direction, etc.... <br /> Public water: � 1 Public sewage: <br /> I. <br /> SUMMARY OR COMMENTS: <br /> u <br /> I recommend: Approval ,,-' Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> 7& <br /> 4 <br /> �t <br /> SUPERVISOR/LEAD SENIOR APPROVAL: -� <br /> :E <br /> Oft HI CHE k,OFFLI, T 'Proofread report? . �'_' =CorrectLAND USE#9 <br /> EH 66 06 Rev 1199 <br /> Gvrrecl CONDITIONS)? ' ° < 'Logged in LAND USE BODX? 'Y-' <br />