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t <br /> N ,TE: .PULL ALL PER1V'-`7S (SEPTIC, WELL, ETC...) P' KE COPIES FOR FILE <br /> LAND USE REPORT APP# 0 {x'01 <br /> EIID RECEIVED APP.REFERRAL: -6— COMPLETE & SUBMIT BY r U <br /> DATE DATE <br /> ATTN: � y <br /> SITE ADDRESS: 6: • rte � I f <br /> In completing the Land Use investigation, drati.,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 /> Supervisor/Lead Senior Comments: <br /> SUPERVISORILEAD SENIOR APPROVAL: <br /> OAII CHE�1�OF]�"LIST Proofread report? F Correct LAND USE#? <br /> EH 06 06 Rev 1199 4 € Correct CONDITION(SJ? °Lagged in LAND USE BOOK? <br />