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NOTE: PULL ALL PERIVI.,S (SEPTIC, WELL, ETC...) Pt,..,,XE COPIES FOR FILE <br /> LAND USE REPORT APP# <br /> END RECEIVED APP.REFERRAL:� COMPLETE & SUBMIT BY -5 <br /> DATE DATE <br /> ATTN: ll <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: /7'y <br /> SUMMARY OR COMMENTS: <br /> 97 <br /> I recommend: Approval Denial Continuance Inspector's Sign e - <br /> Supervisor/Lead Senior Comments: <br /> r 16 04.0 <br /> c /a •o Y <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: _Proofread report? _Correct LAND USE#? <br /> ER 06 06 Rev 1199 11 Correct CONDITION(S)? _Logged is LAND USE BOOK? <br />