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` `� R FILE <br /> NOTE: PULL ALL PERA.,,3 (SEPTIC, WELL, ETC...) a�, ,;CE COPIES FOR <br /> LAND USE REPORT APP# --0 <br /> r / — <br /> EIID RECEIVER APP.REFERRAL: f � ! COMPLETE & SUBMIT BY 3 — <br /> DATE DATE <br /> ATTN: k-e-- j ("— <br /> SITE ADDRESS: — <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 /> i <br /> F <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA II CHECK OFALIST a` � Proofread report? �Correct LAND USE#7,,x <br /> Correct CONDITIONS} E '' Fogged in I,:41VD USE BOOK, <br /> EH 06 06 Rev 1199 ». - <br />