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NOTE: PULL ALL PERMITS (SEPTIC, WELL, ETC...) MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> £HD RECEIVED APP.REFERRAL: -16-aQ COMPLETE & SUBMIT BY —:'OD <br /> DATE DATE <br /> ATTN: rL&4LC A�"�� <br /> SITE ADDRESS: a <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 /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA'7I CHECK QFF,,LrST' g` EPrvareud report a g �Cairect L:4ND USE.C." <br /> q } <br /> EH o6 06 Rev v99 �Cnrrert CDNDITIOPY{S)9� Lagged in LAND ITSE BOQK7� . <br />