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NOTE: PULL ALL PEW.—US (SEPTIC, WELL, ETC...) P—.KE COPIES FOR FILE <br /> LAND USE REPORT APP# b0 <br /> EHD RECEIVED APP.REFERRAL: O 3 COMPLETE & SUBMIT BY <br /> DAT9 <br /> Jolle,,v DATE <br /> ATTN: <br /> SITE ADDRESS: 1 ,�-S-3 -5 <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 /> *�E�Yir�'c�F�c:k�c4rx9c4cic�c9ric9cic�'cic�c*�cic�cxx�c�F*�'cir�FicxicicicicxXicic9c�'c�E*�c�c�cx�cir�'e�'c4cicicicic�cx3c*�c�4�c�Y�F�c*9c 9c�c�ca'cic�c�eic�Fieiricic�cicicic <br /> Supervisor/Lead Senior Comments: <br /> as •0� <br /> SUPERVISORILEAD 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 />