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Jy <br /> NOTE: PULL ALL PtRr-,..,fS (SEPTIC, WELL, ETC... KE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: �I G� COMPLETE & SUBMIT BY <br /> DATE DATE <br /> ATTN• <br /> • gyp� <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...). 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 /> os� <br /> `05 0 K (ZOA, q,2 R <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> oy <br /> �}. /o 'o� <br /> 1 . oo :os- <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />