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y it TJ <br /> NOTE: PULL ALL PEK. , S (SEPTIC, WELL, ETC...) ,AKE COPIES FOR FILE <br /> LAND USE REPORT APP# Y/ <br /> i <br /> EHD RECk IVED APP.REFERRAL: <br /> c COMPLETE & SUBMIT BY C� <br /> D E DATE <br /> 1r <br /> ATTN; 1 <br /> SITE ADDRESS: I leLz—dll <br /> F <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 /> 1 <br /> SUMMARY OR.COMMENTS: <br /> I` <br /> .01 <br /> E)3 66,'A <br /> W <br /> og z �I���� <br /> I recommend: Approval Denial Continuance Inspector's Signator <br /> x$r�e¢c�e a�:yyF$c*3rx xdex eK**dc�c irxndexee'e�e 9cFvc ds is is dcx�r zYx$a'e�r$e$e eF 9c$9c�r 3c*9ckxF de 9e�t�r KBE ie ie'e�c knF h9c.'e*ie�k ie aF$e x�c�'tk�'t 9r%tE xF 9c xic <br /> �I <br /> Supervisor/Lead Senior Comments: <br /> LlM <br /> pR <br /> �N •a <br /> 51 <br /> 0 <br /> ,1 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> p OA IL CHECK OFF LIST 4 Prnafread report? k Carred LAND USE# <br /> EH 06 06 Rev 1199 <br /> Corsect CONpITION(S)Y LAND DISE BOOK <br />