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NOTE: PULL ALL PER S (SEPTIC, WELL, ETC...) Ivr,<KE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL. --3 - COMPLETE & SUBMIT BYP—RYP4S4 /O� <br /> DA DATE <br /> ATTN: <br /> SITE ADDRESS: -Q (�n��� <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 /> 4 .4 <br /> OMMENTS:4 . <br /> I recommend: Approval Denial Continuance Inspector's Signatu,� <br /> *$cic�ck:Ffcdciadsicicdcicic9cick�c�c-.�c�c*�cFc*ic�e�xxiricx�c3c�k$r9c�rit�ric9r3c9c�Y�elr�c�k�cde�'e�e�e�c$rx9ris�'sdc��s�c�'<9cat9c9e$r�'t9e�F>cx 'Ax�eri-. exk�Fdciex <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: �. <br /> SOA II CIIEGK OFFLLST `= Proofread report? :` CpXreCt LAND USE#q` <br /> EH 06 06 Rev il99 ' p ` '' Correct CONDITI4N(S}� Logged in LAND USE BOOK? <br />