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NOTE: PULL ALL PEAS (SEPTIC, WELL, ETC...) 1,!�AKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: I - �40 _Q 1 COMPLETE & SUBMIT BY 7 —� <br /> DATE // DATE <br /> ATTN: i l&L' <br /> SITE ADDRESS: 19 <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 /> s- <br /> n�►�sf- <br /> 43 <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> oy <br /> 03 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> llz— <br /> OA 7I CHECK OFF LIST: —Proofread report? _Correct LAND USE#? <br /> EH 06 06 Rev 1/99 _Correct CONDITION(S)? _Logged in LAND USE BOOK? <br />