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i <br /> NbTE: PULL ALL PERNIrrs (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# �L Iq J <br /> ,r-6-- . <br /> EHD RECEIVED APP.REFERRAL: V COMPLETE & SUBMIT BY <br /> DATC DA <br /> ATTN: `�r <br /> SITE ADDRESS: q <br /> In completing the Land Use investigation, draw a 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 /> tti,^ 11 <br /> Public water: '�( 5 Public sewage:SUMMARY OR OR COMMENTS: <br /> O t,J 211 T C �r u la o <br /> o gA G.c p k G r,1c,sU-t d• I <br /> � C-� �\ 1ZJ v Cie - � ��'h f O� <br /> iA� l <br /> I recommend: Approval Denial Continuance Inspector's Signature Q- <br /> �rirziriricicxic�r�i4cixic9c�Ficxxici�xxir:�rxx�c�c it 9c zic is is is*�c is icxx�r�c�F*s"c�k�c is*�c�kx�c is�'cxx�c is oc�cxic is is is is icxis is icxic 9c is is>F ix icxic is�c icx�cx <br /> Supervisor/Lead Senior Comments: <br /> ff <br /> aZ � ;OS � ow <br /> a a 'ds � gid' ' /� tiw.� ' �►�► ��u-c.,Q�� <br /> i <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 11 CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />