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NOTE: PULL ALL PERA�,..'S (SEPTIC, WELL, ETC—) 1, ICE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> EHD RECEIVED APP.REFERRAL: -17 9 vl COMPLETE & SUBMIT BY _U <br /> DATE DATE <br /> ATTN <br /> SITE ADDRESS: ) `�/ �A i �5 d= 7Z (�L� /�7`C <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: Approv Denial Continuance Inspector's ign e <br /> Supervisor/Lead Seni r �omments: <br /> o-7 <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> 8H 06 06 Rev 1/99 <br /> Correct CONDITION(S)? Logged in LAND USE BOOK? <br />