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TN <br /> NOTE: PULL ALL PERS (SEPTIC, WELL, ETC...) VAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: 5—(5-00 COMPLETE & SUBMIT BY p� <br /> DATE I DATE <br /> ATTN• �( �U� L� Y`c .1 S-fp-� <br /> SITE ADDRESS: Li <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 /> or—o IVr <br /> a � z <br /> I I a� R <br /> ,fes <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �c4r�e�tFF'c�c4cix�c*�c9c�ca'c*�c�c9r�9cF�r9r�r�r'ca'c�c9cx�c�c�e**�c*9c*�c4cF�ck*�c9c*�e�cF9c*a'c�c�cic�c4cicx*�c*ic�c�c�c*�c�cic*�c9e9c�r�c9c'cicF�c*�cicF�c <br /> Supervisor/Lead Senior Comments: <br /> QC LIT dlQ <br /> lI h3 s �" <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 />