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NOTE: PULL ALL PE i S (SEPTIC, WELL, ETC... KE COPIES FOR FILE <br /> LAND USE REPORT APP# n'�.�-0 R -31 <br /> EHD RECEIVED APP.REFERRAL: Q —6-103— COMPLETE & SUBMIT BY /0 — <br /> DATE DATE <br /> ATTN: .J of e R u6 i G1.n e-S <br /> SITE ADDRESS: �S n <br /> In completing the Land Use investigation, draw all Pifblic 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*icicicicocicicxicieicicxicxic�cic�cxicicic�cicicic9cxic�cic�'cxieiricx�cxx�Fx*�'cic�Fx�c�c3c4c�cdcxieicicicicxx�'c�cxicicxicxieic�c9cicxicieicicicicicxicicxdc <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD 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 />