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r1-1 �j LfA <br /> N'aTE: PULL ALL PERNi�S (SEPTIC, WELL, ETC...) T , E COPIES FOR FILE <br /> LAND USE REPORT APP#_ate --q <br /> EFID RECEIVED APP.REFERRAL: `( COMPLETE & SUBMIT BY. <br /> DATE DATE <br /> ATTN: -S t-o_r <br /> SITE ADDRESS: o <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 <br /> I � <br /> `I <br /> I <br /> I <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> II <br /> - I <br /> `I <br /> `I <br /> .I <br /> SUPERVISOR/LEAD SENIOR APPROVAL: �I <br /> 4 �I CH CIC OFF LIST Proofread report? Correct LAND[ISE#?q� <br /> EH 06 06 Rev 1199 ECarreet CDNDITION{5)? R ' Lagged'in LAND LICE BDOK? <br /> II <br />