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A e; <br /> 1 <br /> NOTE: PULL ALL PERKS (SEPTIC, WELL, ETC...) KE COPIES FOR FILE <br /> 7/Ift <br /> LAND USE REPORT APP# K <br /> EHD RECEIVED APP.REFERRAL:S COMPLETE & SUBMIT BY (Q — D, <br /> DATE DATE <br /> ATTN: J d M (,CAdA r5ure-o <br /> SITE ADDRESS: <br /> In completing the Land Use investigation, draw all 4ublic 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 �•R• <br /> s'c�Fxicicxxx�cx�c*�cicxxie�'cie�c�exic�c�E�E4cie�'c�'c�ciric3c�F�'c�c�Yx�e�c9c�c3c�c�e�F�c�e'e�'e�ek�e�c�cie�c�eiexieseieicx�ic�c�"c�z�e�c�e�c�e�cicxic�eicicicicxr.icicx <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST. Proofread report? Correct LAND USE#? <br /> EFI 06 06 Rev 1/99 Correct CONDITION(S)? Logged in LAND USE BOOK? <br />