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NOTE: PULL ALL PERSS (SEPTIC, WELL, ETC...) KE COPIES FORTE <br /> 01*1-4 <br /> LAND USE REPORT APP# <br /> I <br /> � COMPLETE & SUBMIT BY ° S <br /> El�fl RECEIVED APP.REFERRAL:,-5 3 <br /> DA DATE <br /> ATTN: J O - [GUr Q-D arq _BYO Ll 4'6, Y7 <br /> SITE ADDRESS: Q <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 'gnatu <br /> �e�e�'rir3cvFde�'r��'e�ceFicx�c�Firx�e�Jcic�E4cieo'c�'e�Fde:'��rxxx�e:�cxk�ex�Y�ric9c�Fk9c�r�F�:��'c9rdr*kds�F�k�'c�Fde�'eir�F�k�4 ic9cac eJc�eic9cdrxxde��rx3sxxx <br /> Supervisor/Lead Senior Comments: <br /> �' //D ^ �� �r • <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> SOA II CHECK OFF LIST ' Proofread report? Correct LAND USE#� <br /> ' '' Corr`eat <br /> EH 06 06 Rev E199 ECONDITI011(S�?,` Logged In LAND USE BOOR' <br /> � a ��-�f � �.-� � gi, wh <br />