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pa <br /> NOTE: PULL ALL PERKY TS (SEPTIC, WELL, ETC...) *KE COPIES FOR FILE <br /> LAND USE REPORT APP# S - OO—,5) <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY — V-0 <br /> to <br /> DATE n DATE <br /> ATTN• } C k— `j ELF47 n <br /> SITE ADDRESS: I`C( ( ��C 1k.e <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 /> I recommend: Approval Denial Continuance Inspector's Signature <br /> �cxicicirYxFicicx9c'cicicx�c*ie�c�c*xxic9cic�cicic�cicxxicic�cx�Eiciricieicxicicicicic4icxic�cic�cxic�rxxieieicic�c�cxxdcic�'tieicix9r'cicicieic'eieicicicicic�c <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 Correct CONDITION(S)? Logged In LAND USE BOOK? <br />