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NOTE: PULL ALL PERN&S (SEPTIC, WELL, ETC...) IWAKE COPIES FOR FILE <br /> LAND USE REPORT /� APP# <br /> EHD RECEIVED APP.REFERRAL: l 1 �/9 COMPLETE & SUBMIT BY 31-7192 <br /> DATE I 15ATE <br /> ATTN: -r/nA <br /> SITEADDRESS: )375 0 IV, <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 /> JPublic <br /> Public water: � sewage: <br /> SUMMARY OR COMMENTS: <br /> �q <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> � �� <br /> Ll'1 <br /> r— <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA H CHECK OFF LIST: Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 _Correct CONDITION(S)? Logged in LAND USE BOOK? <br />