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NOTE: PULL ALL PERTV'�'S (SEPTIC, WELL, ETC...) l\ yKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: , COMPLETE & SUBMIT BY <br /> DE ATE <br /> 1, <br /> ATTN: (�'.I� �7 r� 66,n q <br /> SITE ADDRESS: -I ✓ D 0 r("f f!� �C1 (,f�CGi(0 ti <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 /> X k�c ai it x�c icx is xic 9c is�c�c�c�cx�F�cxicxxxxicx>cx�cxx�cx�c�c�Fxx�F�c yc*�'c�c�c 7c�c ivkxic is icxic�c it ic>cx xic�c is is is is 9c is zic is icx kirxicxxxic is is k�F it <br /> Supervisor/Lead Senior Comments: <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 />