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NOTE: PULL ALL PER1VtxTS {SEPTIC, WELL, ETC...} MAKE COPIES FOR FILE <br /> LAND USE REPORT APP# — S <br /> EHD RECEIVED APP.REFERRAL: - 0�7�1 COMPLETE & SUBMIT BY — <br /> DATE DATE <br /> ATTN: _ v� .� (I� U e/� <br /> SITE ADDRESS: �k s 7 �_T� .� �_ �c� �< 1 <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 /> R <br /> rllelu <br /> L <br /> - u..iV <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFFKLIST Proofread eport?". Correct LAND USE#? <br /> EUI 06 06 Rev 1199Correct CONDITION(S)7 Logged in LAND USE BOOK? <br />